The synthesis of optical frequencies from the primary cesium microwave standard has traditionally been a difficult problem due to the large disparity in frequency. Recently this field has been dramatically advanced by the introduction and use of mode-locked lasers. This application of mode-locked lasers has been particularly aided by the ability to generate mode-locked spectra that span an octave. This review article describes how mode-locked lasers are used for optical frequency synthesis and gives recent results obtained using them.