Classical Hamiltonian systems with balanced loss and gain(BLG) are considered in this review. A generic Hamiltonian formulation for systems with space-dependent BLG is discussed. It is shown that the loss-gain terms may be removed completely through appropriate co-ordinate transformations with its effect manifested in modifying the strength of the velocity-mediated coupling. The effect of the Lorentz interaction in improving the stability of classical solutions as well as allowing a possibility of defining the corresponding quantum problem consistently on the real line, instead of within Stokes wedges, is also discussed. Several exactly solvable models based on translational and rotational symmetry are discussed which include, coupled cubic oscillators, Calogero-type inverse-square interaction, Landau Hamiltonian etc. An example of Hamiltonian chaos within the framework of a model of coupled Duffing oscillator with BLG is discussed. The role of PT -symmetry on the existence of periodic solution in systems with BLG is critically analyzed. It is conjectured that a non-PT -symmetric system with BLG may admit periodic solution if the linear part of the equations of motion does not contain any velocity mediated interaction and is necessarily PT symmetric -the nonlinear interaction may or may not be PT -symmetric. Results related to dimer and nonlinear Schrödinger equation with BLG are mentioned briefly.