The recent expansion and proliferation of legalized casino gaming has spurred debate at all levels of government. As a result, a number of studies have attempted to quantify many of the economic, social, and fiscal impacts of legalized casino gaming. This study reviewed existing literature on the effects of casino gaming in the Upper Midwest and discussed some of the issues associated with casino activities. The impacts of casino gaming have generally been evaluated at either the local and/or state or regional level. Positive economic impacts have been quantified more often than negative economic impacts. Few studies have attempted to quantify the social costs of casino gaming. The economic impacts of casino activities on local economies have generally been positive, with some debate over the magnitude or importance of those impacts. Other impacts at the local level have been mixed. The economic impacts on state economies are generally measured using gross economic indicators, such as primary and secondary employment and overall economic activity. Many issues remain regarding the real or true economic impacts to state economies, as many studies have not adequately addressed the issue of whether or not gaming revenues represent new wealth to the state. The debate over the impacts of casino gaming is likely to continue. The gambling industry has grown dramatically in many regions of the United States, and so have concerns over the long-term implications of expanded gambling activities.