The use of hypofractionated radiation therapy has increased among many cancers, although its use in head and neck cancers remains limited due to concerns regarding acute and late toxicities. Recent retrospective and prospective studies demonstrate the preliminary safety and efficacy of hypofractionation in the definitive, postoperative, and preoperative settings for head and neck treatment. This article seeks to comprehensively review the rationale and data for novel fractionation schemes in this disease site. We also provide practical clinical and dosimetric insights based on our institutional experiences with hypofractionation in head and neck cancers.