I seek to provide an overview of the historical and geographical emergence of city-regions and to reflect on some of the debates that have arisen in regard to the theoretical status of these phenomena. I briefly describe the growth and spread of city-regions in the world since the mid-1950s and I consider how contemporary capitalism and globalization have fostered the development of this distinctive urban form. The internal organization of city-regions is then examined, with special reference to four generic outcomes: (1) aestheticized land-use intensification; (2) gentrification; (3) social polarization and informality; and (4) postsuburban landscapes. Issues of governance and policy are scrutinized and basic dilemmas of political coordination in city-regions are described. The argument ends with an evaluative review of certain critiques of the city-region idea in the current academic literature.