This paper reviews the understanding of fretting fatigue with an emphasis on the behavior of Ti-6Al-4V. Advances in life prediction and assessment approaches are highlighted. The role of microstructure on fretting fatigue and its use to detect fretting fatigue damage can now be considered in assessment strategies. Various palliatives are used to enhance the fretting fatigue resistance. These include treatments to introduce compressive residual stress and surface coatings that reduce friction and/or protect the underlying structural material.