Along the Pacific coast of North America, from Alaska to Mexico, harmful algal blooms (HABs) have caused losses to natural resources and coastal economies, and have resulted in human sicknesses and deaths for decades. Recent reports indicate a possible increase in their prevalence and impacts of these events on living resources over the last 10–15 years. Two types of HABs pose the most significant threat to coastal ecosystems in this “west coast” region: dinoflagellates of the genera Alexandrium, Gymnodinium, and Pyrodinium that cause paralytic shellfish poisoning (PSP) and diatoms of the genus Pseudo-nitzschia that produce domoic acid (DA), the cause of amnesic shellfish poisoning (ASP) in humans. These species extend throughout the region, while problems from other HABs (e.g., fish kills linked to raphidophytes or Cochlodinium, macroalgal blooms related to invasive species, sea bird deaths caused by surfactant-like proteins produced by Akashiwo sanguinea, hepatotoxins from Microcystis, diarrhetic shellfish poisoning from Dinophysis, and dinoflagellate-produced yessotoxins) are less prevalent but potentially expanding. This paper presents the state-of-knowledge on HABs along the west coast as a step toward meeting the need for integration of HAB outreach, research, and management efforts.