Smoking among commercial and military aviators is a health hazard in the cockpit. Pilots who are required to abstain before and during flight may suffer cockpit performance decrements. This study reviews the physiological, cognitive, behavioral, and psychological effects of smoking withdrawal as they relate to flying performance. The variety of research designs, methodologies, and subject groups is discussed. Findings suggest that heart rate, arousal, vasoconstriction, vigilance, concentration, and energy increase with nicotine use; stress and irritability are reduced with smoking. Withdrawal, on the other hand, produces a decrease in carboxyhemoglobin, digit recall, serial addition/subtraction, and job satisfaction; blood pressure, depression, absenteeism, caloric intake, craving, aggressiveness, confusion, and impulsivity increase with withdrawal. Severity of withdrawal symptoms varied, but most studies report psychological, and/or physiological responses to nicotine withdrawal. The conflict between health and performance is discussed and suggestions for future directions are offered.