Biologists have long known that populations of organisms — microbes, plants, animals — can self-organize into emergent patterns. Yet, the fact that such patterns can arise with remarkable symmetry at the scale of entire ecosystems remains astonishing, even as aerial imagery has documented their existence across all continents. As the enormous scale of landscape patterns makes them experimentally intractable, ecologists have relied on theoretical modelling — typically rooted in physics — to investigate the underlying pattern-forming mechanisms. Such models have succeeded in generating mechanistic hypotheses and indicate that self-organized spatial patterns can reflect the health of an ecosystem. However, most of these hypotheses remain untested. This essay reflects on our current understanding of the causes and consequences of ecosystem-scale pattern formation.