Feral pigs (Sus scrofa L.) are perhaps the most abundant, widespread, and economically significant large introduced vertebrate across the Pacific island region. Unlike many other nonnative invasive species, feral pigs have both cultural and recreational importance in the region, complicating their management. Today, Pacific island feral pigs are a mixture of several strains of domestic swine, Asiatic wild boar, and European wild boar. Due to their generalist diet and rooting behavior, feral pigs alter soils and watersheds and negatively impact native and nonnative flora and fauna. As a result, feral pigs have played a role in the extinction of several species of plants and animals on Pacific islands and have negative effects on both ecotourism and agricultural industries in the region. Despite numerous published studies on feral pigs in the Pacific island region, of which the majority include systematic analyses of original empirical data, some fundamental aspects of feral pig ecology remain poorly characterized, at least partly due to the remote and inaccessible environments that they often inhabit. To address these knowledge gaps, effort should be made to integrate research conducted outside the Pacific island region into local management strategies. This review summarizes the origins, history, ecology, environmental effects, and current management of feral pigs in the Pacific island region; integrates regional scientific findings with those of other insular and continental systems; and identifies current knowledge gaps requiring further research to inform the ecology and management of this impactful invasive species.