Until recently, diagnostic testing in the microbiology laboratory was very similar to what was done 50 or even 100 years ago, with microscopy, culture, and biochemical testing essential to diagnostics. However, we are in the midst of changes that will impact dramatically on the future of clinical microbiology. I will focus in this lecture on three broad areas – microbial identification, antimicrobial susceptibility testing, and laboratory automation. The use of mass spectrometry for identification of bacteria, mycobacteria, and fungi is dramatically changing laboratory workflow, identification accuracy, and time to results. In contrast, we are not able to control the rapidly evolving problems with antibiotic resistant bacteria. Finally, laboratory automation offers the opportunity to eliminate wasteful activities in the laboratory and concentrate on more rapid diagnostic testing that will directly impact on patient management.