The possibility that dark matter at large scales admits a description as a viscous fluid is discussed. The effects of shear viscosity are examined in two scenarios: 1) Dark matter with shear viscosity arising from its fundamental interactions: The back-reaction of fluctuations on the average energy density could accelerate the cosmological expansion. 2) Conventional dark matter in a coarse-grained description: The effect of short-distance (galactic-scale) fluctuations can be mapped onto pressure and viscosity terms in the effective theory of long-distance perturbations. The two-loop nonlinear power spectrum of the long-distance modes within the effective theory agrees well with N-body simulations and displays better convergence properties than standard perturbation theory.