Recent technological advances over the past few decades have enabled the development of fully coupled atmosphere-ocean modeling prediction systems that are used today to support short-term (days to weeks) and medium-term (10–21 days) needs for both the operational and research communities. We overview the coupling framework, including model components and grid resolution considerations, as well as the coupling physics by examining heat fluxes between atmosphere and ocean, momentum transfer, and freshwater fluxes. These modeling systems can be run as fully coupled atmosphere-ocean and atmosphere-ocean-wave configurations. Examples of several modeling systems applied to complex coastal regions including Madeira Island, Adriatic Sea, Coastal California, Gulf of Mexico, Brazil, and the Maritime Continent are presented. In many of these studies, a variety of field campaigns have contributed to a better understanding of the underlying physics associated with the atmosphere-ocean feedbacks. Examples of improvements in predictive skill when run in coupled mode versus standalone are shown. Coupled model challenges such as model initialization, data assimilation, and earth system prediction are discussed.