For more than 100 years, blastomycosis has been recognized as causing significant morbidity and mortality in people and dogs. The disease is rare in cats. Isolation of the organism is difficult, and novel methods to culture environmental samples are forthcoming. The most significant clinical dilemma is the inability to make a timely diagnosis when multiple cytologic samples are unrewarding. This article reviews the literature on advances in epidemiology and serology, clinical presentations, new antifungal drugs, and progress in formulating a vaccine.