Size presses on paper machines are used to apply a solution of a polymer – usually starch – to the surface of the sheet and thereby to increase the stiffness, surface strength, and printing quality of the product. This article reviews publications dealing with the size press equipment, the materials, and factors affecting both the operating efficiency and attributes of the resulting paper. The emergence of film-press equipment (e.g. blade-metering size presses) in the 1980s has greatly decreased the frequency of web breaks and increased productivity. Starch technology at the size press, though relatively mature, continues to evolve. By adjustment of starch attributes, solids levels, and incorporating other additives, modern papermakers can tune size press outcomes to meet a range of paper product requirements, including strength, hydrophobicity, and the reduction of air permeability. By application of various synthetic polymers, mineral particles, and even nanocellulose in combination with starch or other base polymers, there is potential to extend the technology to meet a range of future needs for paper products.