Surgical reconstruction of proximal level nerve repair or long nerve grafts have provided less than optimal results, presenting the opportunity for investigation of alternate reconstructive techniques. Good motor function following an injury to a motor nerve requires a maximal number of motor axons reaching the motor end plate within a critical time period. Nerve transfers eliminate the need for a nerve graft by allowing a direct end to end nerve repair without tension. This article reviews surgical options using nerve transfers for patients with upper and lower extremity nerve injuries.