The study of contextuality has made great strides in recent years. On the mathematical side, we now have a rich understanding of the limits of quantum contextuality thanks to several powerful formalisms [1][2][3][4]. On the conceptual side, there are ongoing discussions both about the reasoning that leads us to prefer non-contextual theories [5,6] and the sorts of models which could naturally be expected to lead to contextuality [7,8]. My aim in this article is to clarify how these various approaches to contextuality relate to one another and to explore what this combined body of work means for a scientific realist. Obviously I will not be able to mention every relevant result, but I aim to cover enough to get a clear picture of the conceptual implications of contextuality.I begin by assessing various proposals for the source of the intuition that there is something problematic about contextuality, ultimately concluding that contextuality is best thought of in terms of fine-tuning. I then argue that as with other fine-tuning problems in quantum mechanics, this behaviour can be understood as a manifestation of teleological features of physics; I therefore suggest that contextuality can be regarded as evidence for the 'all-at-once' approach advocated in refs [9][10][11]. Finally I discuss several formal mathematical frameworks that have been used to analyse contextuality and consider how their specific results should be interpreted.In the course of this discussion I prove several new mathematical results. I use the methods of ref [12] to demonstrate that preparation contextuality is a form of fine-tuning; I show that measurement contextuality can be explained by appeal to a global constraint forbidding closed causal loops; and I demonstrate how negative probabilities arise from a classical ontological model together with an epistemic restriction.