This paper reviews empirically grounded research on practices in game development with the intent to give a comprehensive overview of contemporary development practices used in the video game industry. While there are many intangible elements that inform game development processes, this review specifically covers the more immediate practical challenges. The review covers a total of 48 papers published between 2006 and 2016, which were all subjected to thematic analysis by three reviewers. The results of the review show that an almost universal characteristic of game development is that it is almost impossible to accurately plan a development project in detail, largely due to the soft requirements inherent in game production which emerge mid-process during development projects, during when testing is coupled with continuous ideation and refinement. Practicing game developers have created their own frameworks that accommodate for this lack of planning. They include flat hierarchies, democratic decision-making, creative autonomy, and informal communication, which are designed to create an environment that maintains creativity and openness to product changes long into the production process. These frameworks vary significantly between studios and often between individual projects. This review also shows that the term ‘Agile’, while often used by both researchers and developers to characterize the process of game development, is not an apt descriptor of how game developers actually work. Agile is used as shorthand for unstructured and flexible development, rather than serving as a descriptor of a definable or unified work method. Finally, as companies develop more complicated hierarchies of stakeholders and staff, the desired flexibility and autonomy of game development becomes increasingly complicated to maintain, and often necessitates more formalized management processes and company structures. In these cases, inherent tensions of game development become more pronounced, and continuous creativity is hard to maintain due to a growing need to formalize processes.