NADPH oxidases (NOXs) are integral membrane enzymes that produce reactive oxygen species. Humans have seven NOX enzymes that feature a very similar catalytic core but distinct regulatory mechanisms. The recent structural elucidation of the NOX catalytic domains has been a step forward in the field. NADPH, FAD, and two hemes form a linear array of redox cofactors that transfer electrons across to the two sides of the membrane. Oxygen is reduced through an unusual outer sphere mechanism that does not involve any covalent intermediate with the heme iron. Several recent studies have expanded the roles of NOXs in cell signaling, innate immune response, and cell proliferation including oncogenic transformation. This work reinforces NOX-generated ROS as powerful signaling molecules. A challenging question is to understand the specific mechanisms of enzyme regulation and to harness the growing insight on NOXs’ structure and biochemistry to generate more powerful small-molecule modulators of NOX activities.