The development of physiologically relevant intestinal models fueled by breakthroughs in primary cell-culture methods has enabled successful recapitulation of key features of intestinal physiology. These advances, paired with engineering methods, for example incorporating chemical gradients or physical forces across the tissues, have yielded ever more sophisticated systems that enhance our understanding of the impact of the host microbiome on human physiology as well as on the genesis of intestinal diseases such as inflammatory bowel disease and colon cancer. In this review we highlight recent advances in the development and usage of primary cell-derived intestinal models incorporating monolayers, organoids, microengineered platforms, and macrostructured systems, and discuss the expected directions of the field. Current Approaches to Modeling Intestinal Physiology The small and large intestine, located after the stomach, comprise the lower human gastrointestinal tract and play crucial roles in nutrient absorption and in housing much of the human microbiome (see Glossary) (Figure 1, Key Figure). In the past decade, model systems have attempted to recapitulate the complex, in vivo intestinal physiology using cell lines derived from intestinal tumors such as Caco-2 cells in place of primary epithelial cells. Advanced organ-on-achip systems were created by culturing Caco-2 cells on the geometrically or mechanically engineered platforms to properly mimic the structural and mechanical properties of the human intestine [1-6]. To mimic the mucosal architecture, porous scaffolds were micromolded to villus-like projections on which Caco-2 cells could be cultured [1,6]. To recapitulate the mechanically dynamic environment, microfluidic systems were developed with fluid flowing both above and below a Caco-2 cell layer growing on a rhythmically stretched flexible surface [2-5]. These systems were designed to mimic the shear forces and contractile motions occurring in the small intestine. Caco-2 cells, as well as other tumor cell lines, have also been used as surrogate intestinal epithelial cells to probe the interactions between multiple tissue types [7]. These organ-on-a-chip models incorporating tumor cells offer new abilities to emulate the structure, function, and physiology of the living human intestine that are not possible with conventional tissue-cultured monolayers. However, as our understanding of these organs progresses, it is clear that these prior tumor model systems fall short in their ability to accurately reflect in vivo physiology because the models do not possess all of the intestinal epithelial subtypes and either lack receptors, transporters, drug-metabolizing enzymes, or express these proteins at levels different from in vivo. Thus, in vitro replicas of the intestines that more accurately replicate intestinal physiology are required and will need to utilize primary cells. Accordingly, a suite of platforms employing primary cells in a variety of assay formats, including organoid [8,9], monolayer, and shape...