A family of anti-apoptotic regulators known as inhibitor of apoptosis (IAP) proteins block cell death in response to diverse stimuli. In spite of the fact that cellular IAP1 and 2 (c-IAP1 and 2) were discovered more than 12 years ago, their physiological roles have remained obscure. Several molecular mechanisms were proposed to explain their anti-apoptotic activity, ranging from direct inhibition and ubiquitination of pro-apoptotic molecules, to the activation of pro-survival signaling. New findings present a surprising and complex twists. On the one hand, cIAP1 and c-IAP2 suppress Tumor Necrosis Factor alpha (TNFalpha) stimulated cell death by preventing formation of the TNF Receptor 1 (TNFR1) pro-apoptotic signaling complex. On the other hand, they regulate pro-survival NFkappaB signaling pathways: in the non-canonical pathway, by ubiquitination of NFkappaB-inducing kinase (NIK), and in the canonical pathway, by a yet-to-be-defined mechanism. In addition, c-IAPs self-regulate their protein levels through RING domain mediated auto-ubiquitination. Here, we discuss the most recent progress in our understanding of the biological roles of c-IAPs, as well as the implications of targeting c-IAPs for therapeutic intervention.