More than four decades ago, Rickettsia australis was discovered to be the etiologic agent of Queensland tick typhus (QTT), yet many unanswered questions persist about the ecology, epidemiology, and clinical features of this disease. We review 46 previously published cases of QTT along with 16 cases discovered by active surveillance. QTT is usually a mild disease. Patients often have regional lymphadenopathy and eschars. Some have vesicular rashes. Because clinical features overlap, serologic tests are necessary to distinguish QTT from other endemic Australian rickettsial diseases (scrub and murine typhus). Only two tick vectors of R. australis have been identified: Ixodes holocyclus and Ixodes tasmani. Until rickettsiae are isolated from patients in Victoria and Tasmania, it remains unproven that spotted fever group infections in these locations are due to R. australis. However, available serologic, epidemiologic, and clinical data suggest that QTT is not confined to the area in which R. australis was first isolated (Queensland); rather, it occurs along a 3,200-km span of eastern coastal Australia, from tropical to temperate climates.