We review the phenomenon of ultra-compact H II regions (UCHIIs) as a key phase in the early lives of massive stars. This most visible manifestation of massive star formation begins when the Lyman continuum output from the massive young stellar object becomes sufficient to ionize the surroundings from which it was born. Knowledge of this environment is gained through an understanding of the morphologies of UCHII regions and we examine the latest developments in deep radio and mid-IR imaging. SPITZER data from the GLIMPSE survey are an important new resource in which PAH emission and the ionizing stars can be seen. We review the role played by strong stellar winds from the central stars in sweeping out central cavities and causing the limb-brightened appearance. A range of evidence from velocity structure, proper motions, the molecular environment and recent hydrodynamical modeling indicates that cometary UCHII regions require a combination of champagne flow and bow shock motion. Finally, we discuss the class of hyper-compact H II regions or broad recombination line objects. They are likely to mark the transition soon after the breakout of the Lyman continuum radiation from the young star. Models for these objects are presented, including photo-evaporating disks and ionized accretion flows that are gravitationally trapped. Evolutionary scenarios tracing young massive stars passage through these ionized phases are discussed.
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