Advances in hard-ware and soft-ware for electron cryo-microscopy and tomography have provided unprecedented structural insights into large protein complexes in bacterial membranes. Tomographic volumes of native complexes in situ, combined with other structural and functional data, reveal functionally important conformational changes. Here, we review recent progress in elucidating the structure and mechanism of dual-membrane-spanning nanomachines involved in bacterial motility, adhesion, pathogenesis and biofilm formation, including the type IV pilus assembly machinery and the type III and VI secretions systems. We highlight how these new structural data shed light on the assembly and action of such machines and discuss future directions for more detailed mechanistic understanding of these massive, fascinating complexes.