The subcontinent of India occupies a large area of the tropical Indian Ocean, but it has a scant growth of coral reefs along its coasts. Several factors limit reef development here, chief among them being turbid waters stirred by monsoonal systems, fresh water runoff from rivers, and a heavy human population and development pressure along the entire coastline. The island complexes around India, in contrast, show healthy reef growth and support high species diversities. The biological affinities of the reefs include species assemblages typical of the western Indian Ocean and the southeast Asian and central Pacific fauna, and a large variety of habitats and environmental conditions. The reefs of India and Sri Lanka include some of the most used and degraded, as well as some of the most untouched in the region. Although marine protected areas in this region originate from the 1980s, environmental managers rely on an incomplete knowledge of the status and ecology of the reefs. With increasing resource-extraction pressure on these reefs, due to increasing human population and tourism, there is a danger of losing these ecosystems through ignorance and unplanned management. In this chapter we will give a broad overview of the physical and biogeographic influences that shape the reefs of the subcontinent and its islands, and present the major threats to their conservation. The conservation of these reefs may be more limited by their shared cultural and economic institutions so we will also attempt to synthesize the social, economic, and political environment within which rational management will take place, and to identify priority areas for future research and management.