The southeastern United States is characterized as humid subtropical and is subject to extended periods of high ambient temperature and relative humidity. Because the primary nonevaporative means of cooling for the cow (radiation, conduction, convection) become less effective with rising ambient temperature, the cow becomes increasingly reliant upon evaporative cooling in the form of sweating and panting. High relative humidity compromises evaporative cooling, so that under hot, humid conditions common to the Southeast in summer the dairy cow cannot dissipate sufficient body heat to prevent a rise in body temperature. Increasing air temperature, temperature-humidity index and rising rectal temperature above critical thresholds are related to decreased dry matter intake (DMI) and milk yield and to reduced efficiency of milk yield. Modifications including shade, barns which enhance passive ventilation, and the addition of fans and sprinklers increase body heat loss, lowering body temperature and improving DMI. New technologies including tunnel ventilation are being investigated to determine if they offer cooling advantages. Genetic selection for heat tolerance may be possible, but continued selection for greater performance in the absence of consideration for heat tolerance will result in greater susceptibility to heat stress. The nutritional needs of the cow change during heat stress, and ration reformulation to account for decreased DMI, the need to increase nutrient density, changing nutrient requirements, avoiding nutrient excesses and maintenance of normal rumen function is necessary. Maintaining cow performance in hot, humid climatic conditions in the future will likely require improved cooling capability, continued advances in nutritional formulation, and the need for genetic advancement which includes selection for heat tolerance or the identification of genetic traits which enhance heat tolerance.