The astrophysical processes that led to the formation of the first seed black holes and to their growth into the supermassive variety that powers bright quasars at z ∼ 6 are poorly understood. In standard ΛCDM hierarchical cosmologies, the earliest massive holes (MBHs) likely formed at redshift z ≳ 15 at the centers of low-mass (M ≳ 5 × 105 M⊙) dark matter “minihalos”, and produced hard radiation by accretion. FUV/X-ray photons from such “miniquasars” may have permeated the universe more uniformly than EUV radiation, reduced gas clumping, and changed the chemistry of primordial gas. The role of accreting seed black holes in determining the thermal and ionization state of the intergalactic medium depends on the amount of cold and dense gas that forms and gets retained in protogalaxies after the formation of the first stars. The highest resolution N-body simulation to date of Galactic substructure shows that subhalos below the atomic cooling mass were very inefficient at forming stars.