On a 24/7 railway, managing the risks of operator fatigue is crucial for maintaining the reliability and safety of the system. Whilst there is a substantial body of scientific literature covering the causes and effects of fatigue, a recent accident investigation report exposed gaps in our applied knowledge regarding barriers to reporting fatigue, and the problems of monitoring and mitigating the risk arising from fatigue. This paper responds to that call by reviewing literature and practices regarding fatigue management in rail and other safety-critical industries, before focusing on potential solutions for assessing, monitoring and counteracting fatigue both before and during a shift. The authors conclude by identifying areas for future work in this field.