This paper presents a review of the existing fermentation processes for the production of medium-chain-length poly-3-hydroxyalkanoates (MCL-PHAs). These biodegradable polymers are usually produced most efficiently from structurally related carbon sources such as alkanes and alkanoic acids. Unlike alkanoic acids, alkanes exhibit little toxicity but their low aqueous solubility limits their use in high density culture. Alkanoic acids pose little mass transfer difficulty, but their toxicity requires that their concentration be well controlled. Using presently available technology, large-scale production of MCL-PHA from octane has been reported to cost from US $5 to 10 per kilogram, with expenditures almost evenly divided between carbon source, fermentation process, and the separation process. However, MCL-PHAs, even some with functional groups in their subunits, can also be produced from cheaper unrelated carbon sources, such as glucose. Metabolic engineering and other approaches should also allow increased PHA cellular content to be achieved. These approaches, as well as a better understanding of fermentation kinetics, will likely result in increased productivity and lower production costs.