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Transmission of trypanosomatids to their mammalian hosts requires a complex series of developmental transitions in their insect vectors, including stable attachment to an insect tissue. While there are many ultrastructural descriptions of attached cells, we know little about the signaling events and molecular mechanisms involved in this process. Each trypanosomatid species attaches to a specific tissue in the insect at a particular stage of its life cycle. Attachment is mediated by the flagellum, which is modified to accommodate a filament-rich plaque within an expanded region of the flagellar membrane. Attachment immediately precedes differentiation to the mammal-infectious stage and in some cases a direct mechanistic link has been demonstrated. In this review, we summarize the current state of knowledge of trypanosomatid attachment in insects, including structure, function, signaling, candidate molecules, and changes in gene expression. We also highlight remaining questions about this process and how the field is poised to address them through modern approaches.