Osteochondral defects occur as a result of disease or acute injury and have very poor repair potential. Current approaches are usually a temporary solution, and the final fate of the patient is generally to undergo surgery and replacement of the joint with a prosthetic. This chapter will discuss the tissue engineering approaches to osteochondral repair from the perspective of the scaffold considerations needed to develop a viable substitute to joint replacement. Bone and cartilage are two very different tissues with unique characteristics and properties. For example, the avascular nature of cartilage compared with the highly vascularized bone creates a unique set of challenges for the tissue engineer. Mechanical properties and differences between the two tissues also must be carefully accounted for. Finally this chapter discusses current approaches to joint repair and postulates some potential future options.