Underground structures are being constructed at an increasing rate in seismic prone areas, to facilitate the expanding needs of societies. Considering the vital role of this infrastructure in densely populated urban areas and interurban transportation networks, as well as the significant losses associated with potential seismically induced damage, its assessment against seismic hazard is of great importance for stakeholders, operators, and governmental bodies. This paper presents a state-of-the-art review of current developments in the assessment of seismic vulnerability of tunnels and underground structures. Methods for the development of fragility functions for the assessment of bored tunnels in rock or alluvial, and cut and cover tunnels and subways in alluvial, against ground seismic shaking and earthquake-induced ground failures are presented. Emphasis is placed on the estimation of the capacity of the examined structures, the selection of appropriate intensity measures to express seismic intensity, the development of rational probabilistic seismic demand models and the estimation of epistemic and aleatoric uncertainties, related to the seismic fragility of underground structures. Through the discussion, acknowledged gaps in the relevant literature are highlighted.