The pregnane X receptor (PXR) is a promiscuous nuclear receptor that responds to a wide variety of drugs, xenobiotics and endogenous compounds, and plays a critical role in mediating drug-drug interactions in humans. PXR is the master regulator of the expression of the CYP3A4 gene, which encodes for the most abundant and promiscuous drug-metabolizing enzyme in humans. PXR also regulates the expression of other genes involved in xenobiotic metabolism, including CYP2C8, CYP2C9, CYP2B6, GSTA2 and MDR1, as well as genes critical to bile acid metabolism. While PXR functions as a xenobiotic sensor in numerous vertebrates, its relatively low sequence conservation across species causes the PXRs from different organisms to respond to distinct subsets of xenobiotics. Thus, PXR promiscuity is directed and not random. The recent determination of crystal structures of the ligand binding domain of human PXR has provided the first detailed molecular view of this promiscuous receptor, and has advanced our understanding of its varied biological functions. We review the evidence establishing the binding promiscuity of PXR and its directed specificity in different species, and analyze the structural determinants of these characteristics. In addition, we examine the relationship between the interaction of PXR with ligands and the manner in which CYP3A4 is thought to bind to substrate molecules. The accumulating structural and functional data on PXR may facilitate the development of improved methods for in vitro, in vivo and in silico screening for PXR activation.