Boiler tubes subjected to cyclic or fluctuating loads over extended periods of time are prone to fatigue failure. Fatigue can occur at relatively low stresses and is implicated in almost 80% of the tube failures in firetube boilers. This chapter covers the most common forms of boiler tube fatigue, including mechanical or vibrational fatigue, corrosion fatigue, thermal fatigue, and creep-fatigue interaction. It discusses the causes, characteristics, and impacts of each type and provides several case studies.