Early studies suggested there was a severe problem with the fatigue resistance of some bulk metallic glasses (BMGs) and BMG matrix composites, while more recent studies begin to demonstrate a wide variety of fatigue behaviors may be possible for both fully amorphous BMGs and their composites. However, in order to truly understand and control the fatigue behavior of these materials, the role of such factors as thermomechanical processing, the corresponding glass structure, environment, and defects must be understood. Additionally, it is important to understand how these factors relate to the mechanisms of fatigue. This article reviews the current understanding in this regard, and identifies some of the challenges for the future development of fatigue-resistant BMG-based materials.