The extent of T cell activation, proliferation, and survival that follows T cell receptor ligation is controlled by several factors including the strength of TCR stimulation, the availability of pro-survival cytokines, and the presence or absence of co-stimulatory signals. In addition to engagement of the CD28 co-stimulatory receptor by its natural ligands, B7.1 (CD80) and B7.2 (CD86), recent work has begun to elucidate the mechanisms by which signaling through the OX40 (CD134) co-stimulatory receptor, a member of the TNFR super-family, affects T cell responses. Importantly, OX40 ligation has been shown to augment CD4 and CD8 T cell clonal expansion, effector differentiation, survival, and in some cases, abrogate the suppressive activity of regulatory FoxP3+CD25+CD4+ T cells. In this review, we will focus on the mechanisms regulating OX40 expression on activated T cells as well as the role of OX40-mediated co-stimulation in boosting T cell clonal expansion, effector differentiation, and survival.