Resting state fMRI (rsfMRI) as a technique showed much initial promise for use in psychiatric and neurological diseases where diagnosis and treatment were difficult. To realize this promise, many groups have moved towards examining “dynamic rsfMRI,” which relies on the assumption that rsfMRI measurements on short time scales remain relevant to the underlying neural and metabolic activity. Many dynamic rsfMRI studies have demonstrated differences between clinical or behavioral groups beyond what static rsfMRI measured, suggesting a neurometabolic basis. Correlative studies combining dynamic rsfMRI and other physiological measurements have supported this. However, they also indicate multiple mechanisms and, if using correlation alone, it is difficult to separate cause and effect. Hypothesis-driven studies are needed, a few of which have begun to illuminate the underlying neurometabolic mechanisms that shape observed differences in dynamic rsfMRI. While the number of potential noise sources, potential actual neurometabolic sources, and methodological considerations can seem overwhelming, dynamic rsfMRI provides a rich opportunity in systems neuroscience. Even an incrementally better understanding of the neurometabolic basis of dynamic rsfMRI would expand rsfMRI's research and clinical utility, and the studies described herein take the first steps on that path forward.