The development of structure-switching electrochemical, aptamer-based sensors over the past ~10 years has lead to a variety of reagentless sensors capable of analytical detection in a range of sample matrices. The crux of this methodology is the coupling of target-induced conformation changes of a redox-labeled aptamer with electrochemical detection of the resulting altered charge transfer rate between the redox molecule and electrode surface. Using aptamer recognition expands the highly sensitive detection ability of electrochemistry to a range of previously inaccessible analytes. In this review, we focus on the methods of sensor fabrication and how sensor signaling is affected by fabrication parameters. We then discuss the fundamentals of sensor signaling, as well as quantitative characterization of the analytical performance of electrochemical, aptamer-based sensors. Using illustrative examples, we highlight recent advances in the field that impact important areas of analytical chemistry. Finally, we discuss challenges and prospects for this class of sensors.