This paper reflects on the issues and opportunities raised by the use of Agile practices in the development of high-integrity software, based on the scientific literature, projects, and our own understanding of the relevant regulatory regimes, standards and markets. In particular, this paper considers the assumptions that underpin Agile practices and where these seem to conflict with the disciplines of high-integrity development. Conversely, we'll consider some opportunities where an Agile approach could be significantly improved by the adoption of high-integrity practices.