Approach–avoidance conflict has been linked to anxiety and occurs when a stimulus or situation is associated with reward and punishment. Although rodent work has implicated the hippocampus in approach–avoidance conflict processing, there is limited data on whether this role applies to learned, as opposed to innate, incentive values, and whether the human hippocampus plays a similar role. Using functional neuroimaging with a novel decision-making task that controlled for perceptual and mnemonic processing, we found that the human hippocampus was significantly active when approach–avoidance conflict was present for stimuli with learned incentive values. These findings demonstrate a role for the human hippocampus in approach–avoidance decision making that cannot be explained easily by hippocampal-dependent long-term memory or spatial cognition.