Tissue fibrosis occurs with excessive extracellular matrix (ECM) deposition from myofibroblasts resulting in tissue scarring and inflammation. It is driven by multiple mediators, such as the G-protein coupled receptor ligands lysophosphatidic acid (LPA) and endothelin (ET-1) as well as signaling by transforming growth factor β (TGFβ), connective tissue growth factor (CTGF), and integrins. Fibrosis contributes to 45% of deaths in the developed world. As current therapeutic options for tissue fibrosis are limited and organ transplantation is the only effective treatment for end-stage disease, there is an imminent need for efficacious antifibrotic therapies. This review discusses the various molecular pathways involved in fibrosis. It highlights the Rho GTPase signaling pathway and its downstream gene transcription output through myocardin-related transcription factor (MRTF) and serum response factor (SRF) as a convergence point for targeting this complex set of diseases.