Plasmonic modes confined to metallic nanostructures at the atomic and molecular scale push the boundaries of light–matter interactions. Within these extreme plasmonic structures of ultrathin nanogaps, coupled nanoparticles, and tunnelling junctions, new physical phenomena arise when plasmon resonances couple to electronic, exitonic, or vibrational excitations, as well as the efficient generation of non-radiative hot carriers. This review surveys the latest experimental and theoretical advances in the regime of extreme nano-plasmonics, with an emphasis on plasmon-induced hot carriers, strong coupling effects, and electrically driven processes at the molecular scale. We will also highlight related nanophotonic and optoelectronic applications including plasmon-enhanced molecular light sources, photocatalysis, photodetection, and strong coupling with low dimensional materials.