Although neurotransmitters are present in pancreatic islets of Langerhans and can be shown to alter hormone secretion, their precise physiological roles in islet function and their cellular mechanisms of action are unclear. Recent research has identified specific neurotransmitter receptor isoforms in islets that may be important physiologically, because selective receptor agonists activate islet ion channels, modify intracellular [Ca²⁺], and affect secretion. This article focuses on the putative roles of acetylcholine, glutamate, and GABA in islet function. It has been hypothesized that acetylcholine potentiates insulin secretion by either promoting Ca release from cellular stores, activating a store depletion-activated channel, or activating a novel Na channel. GABA and glutamate, in contrast, have been proposed to mediate a novel paracrine signaling pathway whereby α- and β-cells communicate within the islet. The evidence supporting these hypotheses will be critically evaluated.