Sepsis affects the cardiovascular system through multiple mechanisms, and often these derangements result in tissue hypoperfusion. Tissue hypoperfusion is often present in the setting of overt shock, but it can also be present in patients without obvious shock physiology. If left untreated, tissue hypoperfusion contributes to the development of multiple organ dysfunction and, ultimately, death. Therefore, it is critical for the clinician to understand the pathophysiology, recognition, and treatment of sepsis-induced hypoperfusion.