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Standard accretion disk models do a poor job of explaining many observational aspects of luminous AGN,even when they incorporate sophisticated atmosphere and radiative transfer calculations.This is in sharp contrast to the situation in stellar mass black holes,where the models actually do quite well.I will review some of the recent ongoing progress in understanding the structure of black hole accretion in the high luminosity regime,which is expected to make revolutionary advances in the next few years thanks to the fact that global radiation MHD simulations are now becoming a reality.I will also discuss some of the ideas that have been recently proposed to bring models more in line with observations.