Emphysema poses a considerable burden on healthcare resources. In economic terms, the cost of chronic obstructive pulmonary disease (COPD) in the United States alone has been estimated to exceed $30 billion in direct and indirect costs. Despite ever-changing pharmacologic advances, we have yet to make a significant impact on disease progression using a purely medical approach. However, several surgical procedures, some developed over 50 years ago, have demonstrated therapeutic benefit in treating patients with COPD. There are currently 3 surgical options for advanced COPD: bullectomy, lung volume reduction surgery (LVRS), and transplantation. There are also several novel minimally invasive bronchoscopic therapies that are currently being studied. One or more of these options may best suit a particular patient based on their underlying disease. This review helps healthcare practitioners understand how emphysema impacts pulmonary function and reviews surgical methods that may improve this disease state. The goal is to help guide physicians and caregivers to the most appropriate therapy for each individual patient.