The tight junction, or zonula occludens, forms an intercellular barrier between epithelial cells within the gastrointestinal tract and liver and, by limiting the movement of water and solutes through the intercellular space, maintains the physicochemical separation of tissue compartments. The paracellular barrier properties of junctions are regulated and quite different among epithelia. The junction also forms an intramembrane barrier between the apical and basolateral membrane domains, contributing to segregation of biochemically distinct components of these plasma membrane surfaces. Here we briefly review three rapidly developing areas of medically relevant basic knowledge about the tight junction. First, we describe the presently incomplete knowledge of the molecular structure of the tight junction as a framework for understanding its functional properties. Second, we consider experimental evidence defining how the barrier properties of junctions are physiologically regulated and, third, how barrier properties are specifically altered in, and contribute to, pathologic processes affecting epithelia.