Inference-time computation offers a powerful axis for scaling the performance of language models. However, naively increasing computation in techniques like Best-of-N sampling can lead to performance degradation due to reward hacking. Toward a theoretical understanding of how to best leverage additional computation, we focus on inference-time alignment, which we formalize as the problem of improving the quality of responses drawn from a pre-trained policy, given a prompt of interest and access to an imperfect reward model. We analyze the performance of inference-time alignment algorithms in terms of (i) response quality, and (ii) compute, and provide new results that highlight the importance of the pre-trained policy's coverage over high-quality responses for performance and compute scaling: 1. We show that Best-of-$N$ alignment with an ideal choice for $N$ can achieve optimal performance under stringent notions of coverage, but provably suffers from reward hacking when $N$ is large, and fails to achieve tight guarantees under more realistic coverage conditions. 2. We introduce $\texttt{InferenceTimePessimism}$, a new algorithm which mitigates reward hacking through deliberate use of inference-time compute, implementing the principle of pessimism in the face of uncertainty via rejection sampling; we prove that its performance is optimal and does not degrade with $N$, meaning it is scaling-monotonic. We complement our theoretical results with an experimental evaluation that demonstrate the benefits of $\texttt{InferenceTimePessimism}$ across a variety of tasks and models.