Ramularia leaf spot is an emerging pathogen across barley growing regions of the world. It's rise from minor to major disease has been rapid over the last twenty years. The causal pathogen, Ramularia collo-cygni is poorly understood but it has been shown to have a complex life cycle and the ability to exist on many hosts in an endophytic state. The rate of development of fungicide resistance in the fungus is also extremely fast and many of the major single site fungicides are no longer effective in many countries. With multisite fungicides having their approval or reconsidered and no consistent varietal resistance available, control of the disease is increasing challenging. This chapter reviews the latest research into Ramularia biology and control and highlights the areas where recent advances have been made.