This paper is a tutorial-style introduction to a special session on: Effective Voltage Scaling in the Late CMOS Era. It covers the fundamental challenges and associated solution strategies in pursuing very low voltage (VLV) designs. We discuss the performance and system reliability constraints that are key impediments to VLV. The associated trade-offs across power, performance and reliability are helpful in inferring the optimal operational voltage-frequency point. This work was performed under the auspices of an ongoing DARPA program (named PERFECT) that is focused on maximizing system-level energy efficiency.