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RNA modifications are present in all three kingdoms of life and detected in all classes of cellular RNAs. RNA modifications are diverse, with more than 100 types of chemical modifications identified to date. These chemical modifications expand the topological repertoire of RNAs and are expected to fine-tune their functions. Ribosomal RNA (rRNA) contains two types of covalent modifications, either methylation on the sugar (Nm) or bases (mN), or base isomerization (conversion of uridine into pseudouridines, "). Pseudouridylations and ribose methylations are catalyzed by site-specific H/ACA and C/D box snoRNPs, respectively. The RNA component (snoRNA) of both types of snoRNPs is responsible for the site selection by base pairing with the rRNA substrate, whereas the protein component catalyzes the modification reaction: Nop1 in C/D box and Cbf5 in H/ACA box snoRNPs. Contrastingly, base methylations are performed by snoRNA independent, ‘protein-only’, methyltransferases (MTases). rRNA modifications occur at highly conserved positions, all clustering around functional ribosomal sites. Mutations in factors involved in rRNA modification have been linked to severe human diseases (e.g. X-linked Dyskeratosis congenita). Emerging evidences indicate that heterogeneity in RNA modification prevails, i.e. not all positions are modified at all time, and the concept of ‘specialized ribosomes’ has been coined. rRNA modification heterogeneity has been correlated with disease etiology (cancer), and shown to play a role in cell differentiation(hematopoiesis). Remarkably, alteration in rRNA modification patterns profoundly affects the preference of ribosomes for cap- versus IRESdependent translation initiation, with major consequences on cell physiology.