Luminous water maser emission in the 6_(16)-5_(23) line at 22 GHz has been detected from two dozen galaxies. In all cases the emission is confined to the nucleus and has been found only in AGN, in particular, in Type 2 Seyferts and LINERs. I argue that most of the observed megamaser sources are powered by X-ray irradiation of dense gas by the central engine. After briefly reviewing the physics of these X-Ray Dissociation Regions, I discuss in detail the observations of the maser disk in NGC 4258, its implications, and compare alternative models for the maser emission. I then discuss the observations of the other sources that have been imaged with VLBI to date, and how they do or do not fit into the framework of a thin, rotating disk, as in NGC 4258. Finally, I briefly discuss future prospects, especially the possibility of detecting other water maser transitions.