There has been considerable progress in our understanding of how massive stars form but still much confusion as to why they form. Recent work from several sources has shown that the formation of massive stars through disc accretion, possibly aided by gravitational and Rayleigh-Taylor instabilities is a viable mechanism. Stellar mergers, on the other hand, are unlikely to occur in any but the most massive clusters and hence should not be a primary avenue for massive star formation. In contrast to this success, we are still uncertain as to how the mass that forms a massive star is accumulated. there are two possible mechanisms including the collapse of massive prestellar cores and competitive accretion in clusters. At present, there are theoretical and observational question marks as to the existence of high-mass prestellar cores. theoretically, such objects should fragment before they can attain a relaxed, centrally condensed and high-mass state necessary to form massive stars. Numerical simulations including cluster formation, feedback and magnetic fields have not found such objects but instead point to the continued accretion in a cluster potential as the primary mechanism to form high-mass stars. Feedback and magnetic fields act to slow the star formation process and will reduce the efficiencies from a purely dynamical collapse but otherwise appear to not significantly alter the process.