Optimal mechanism design enjoys a beautiful and well-developed theory, and also a number of killer applications. Rules of thumb produced by the field influence everything from how governments sell wireless spectrum licenses to how the major search engines auction off online advertising. There are, however, some basic problems for which the traditional optimal mechanism design approach is ill-suited---either because it makes overly strong assumptions, or because it advocates overly complex designs. This survey reviews several common issues with optimal mechanisms, including exorbitant communication, computation, and informational requirements; and it presents several examples demonstrating that passing to the relaxed goal of an approximately optimal mechanism allows us to reason about fundamental questions that seem out of reach of the traditional theory.