Hypersaline habitats are generally defined as those with salinities in excess of 40 ppt. Well-known hypersaline regions (e.g. salt and soda lakes) have a well-earned reputation for being among the most inhospitable habitats in the world, and fish endemic to these areas have been the subject of much research related to extremophile physiology. Yet, marine coastal hypersalinity is both a common occurrence and a growing consideration in many marine coastal ecosystems, in part owing to human influence (e.g. evaporation, river diversion, desalination effluent). Importantly, any increase in salinity will elevate the osmoregulatory challenges experienced by a fish, which must be overcome by increasing the capacity to imbibe and absorb water and excrete ions. While great attention has been given to dynamic osmoregulatory processes with respect to freshwater to seawater transitions, and to the extreme hypersalinity tolerance that is associated with the adoption of an osmo-conforming strategy, relatively little focus has been placed on the physiological implications of moderate hypersalinity exposures (e.g. ≤ 60 ppt). Importantly, these exposures often represent the threshold of osmoregulatory performance owing to energetic constraints on ion excretion and efficiency limitations on water absorption. This review will explore the current state of knowledge with respect to hypersalinity exposure in euryhaline fishes, while placing a particular focus on the physiological constraints, plasticity and downstream implications of long-term exposure to moderate hypersalinity.