Tetrodotoxin (TTX) is a potent toxin that specifically binds to voltage gated sodium channels. TTX binding physically blocks the flow of sodium ions through the channel, thereby preventing action potential (AP) generation and propagation. TTX has different binding affinities for different sodium channel isoforms. These differences are imparted by amino acid substitutions. Such substitutions confer TTX resistance to a variety of species. Tetrodotoxin resistance, however, may come at a cost to performance caused by changes in the biophysical properties and/or ion selectivity of the TTX resistant sodium channels. We here review the properties of sodium channels and their interaction with TTX, and look at some special examples of TTX resistant channels wherein the benefit of toxin resistance may be offset by other behavioral costs.