Ionic liquids were initially proposed as replacements for conventional organic solvents; however, their chemistry has developed remarkably and offers unexpected opportunities in numerous fields, ranging from electrochemistry to biology. As a consequence of ionic liquids advancing towards potential and actual applications, a comprehensive determination of their environmental, health and safety impact is now required. This critical review aims to present an overview of the current understanding of the toxicity and environmental impact of the principal ionic liquid groups, and highlights some emerging concerns. Each cation type is considered separately, examining the significance of the biological data, and identifying the most critical questions, some yet unresolved. The need for more, and more detailed, studies is highlighted (176 references).