Spa tourism is one of the oldest forms of tourism which continuously evolved in time as the leisure industry paradigm and the consumers’ behavior changed. Similar to other countries in Central and Eastern Europe, spa tourism is an old phenomenon in Romania which expanded to the dimensions of a well defined tourism industry during the mass tourism period which also corresponded to the communism epoch. Although severely affected by the major political and socio-economic changes which occurred after the Revolution in 1989, this industry coexists with new emergent forms of tourism orienting, itself towards new dimensions embraced by the contemporary leisure consumerism (e.g. medical tourism, cosmetic treatments). Lying on considerable balneal and climate resources and displaying an important communist heritage both in physical terms (large and massive tourism structures) and in virtual and psychological terms (social supportive ticket granting system), Romanian spa tourism faces various challenges in the attempt to adapt in a new tourism era.