The effects of high ambient temperatures on production animals, once thought to be limited to tropical areas, has extended into northern latitudes in response to the increasing global temperature. The number of days where the temperature-humidity index (THI) exceeds the comfort threshold (>72) is increasing in the northern United States, Canada, and Europe. Compounded by the increasing number of dairy animals and the intensification of production, heat stress has become one of the most important challenges facing the dairy industry today. The objectives of this review were to present an overview of the effects of heat stress on dairy cattle welfare and highlight important research gaps in the literature. We will also briefly discuss current heat abatement strategies, as well as the sustainability of future heat stress management. Heat stress has negative effects on the health and biological functioning of dairy cows through depressed milk production and reduced reproductive performance. Heat stress can also compromise the affective state of dairy cows by inducing feelings of hunger and thirst, and we have highlighted the need for research efforts to examine the potential relationship between heat stress, frustration, aggression, and pain. Little work has examined how heat stress affects an animal's natural coping behaviors, as well as how the animal's evolutionary adaptations for thermoregulation are managed in modern dairy systems. More research is needed to identify improved comprehensive cow-side measurements that can indicate real-time responses to elevated ambient temperatures and that could be incorporated into heat abatement management decisions.