Microbes such as bacteria, fungi, archaea, protists, and viruses are ubiquitous and people are exposed to them continuously. Endotoxin is a component of the outer membrane of Gram-negative bacteria and a potent proinflammaotry substance. When a person is exposed to environmental endotoxin, an innate immune response is initiated upon the initial recognition and this response produces various inflammatory mediators and recruits inflammatory cells to the exposed tissues. A purified chemical form of endotoxin is called lipopolysaccharide (LPS), and the lipid A portion of the molecule is a biologically active moiety. Exposure to endotoxin may result in various complex health effects depending on time, route, and dose of exposure, as well as host susceptibility. Gene-environment interactions play important roles in health effects of endotoxin exposure, e.g. development or aggravation of asthma. To accurately assess exposure to endotoxin in environmental or epidemiologic studies, methods of sampling, extraction, and analysis must be carefully selected since the selected methods may substantially affect analytical results and there is no internationally-agreed standard method to date. The lack of a standardized method hampers the establishment of exposure-response relationships. While an internationally-agreed health-based exposure limit does not exist, the Dutch Expert Committee on Occupational Safety recently recommended $90EU/m^3$ as a health-based occupational exposure limit. The current article reviews various scientific issues on how we measure environmental endotoxin and the health effects of endotoxin exposure.