Neutrino–neutrino refraction dominates the flavor evolution in core-collapse supernovae, neutron star mergers, and the early Universe. Ordinary neutrino flavor conversions develop on timescales determined by the vacuum oscillation frequency. However, when the neutrino density is large enough, collective flavor conversions may arise because of pairwise neutrino scattering. Pairwise conversions are deemed fast because they are expected to occur on timescales that depend on the neutrino–neutrino interaction energy (i.e., on the neutrino number density) and are regulated by the angular distributions of electron neutrinos and antineutrinos. The enigmatic phenomenon of fast pairwise conversions has been overlooked for a long time. However, because of the fast conversion rate, pairwise conversions could occur in the proximity of the neutrino decoupling region with yet-to-be-understood implications for the hydrodynamics of astrophysical sources and the synthesis of the heavy elements. We review the physics of this fascinating phenomenon and its implications for neutrino-dense sources. Expected final online publication date for the Annual Review of Nuclear and Particle Science, Volume 71 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.