In recent years, the number of lipids implicated in the regulation of the synaptic vesicle exocytosis has risen dramatically. It is now clear that lipids such as the phosphoinositides, arachidonic acid, lysophospholipids, and cholesterol play a critical regulatory role in the processes leading up to exocytosis. Lipids may affect membrane fusion reactions by altering the physical properties of the membrane, recruiting key regulatory proteins, concentrating proteins into exocytic “hot spots,” or modulating protein function allosterically. This chapter discusses the different classes of lipids, the evidence linking them to secretory vesicle exocytosis, how they are thought to act to regulate key steps in the multistep process leading to exocytosis, and future directions.