We study matching markets with aligned preferences and establish a connection between common design objectives -- stability, efficiency, and fairness -- and the theory of optimal transport. Optimal transport gives new insights into the structural properties of matchings obtained from pursuing these objectives, and into the trade-offs between different objectives. Matching markets with aligned preferences provide a tractable stylized model capturing supply-demand imbalances in a range of settings such as partnership formation, school choice, organ donor exchange, and markets with transferable utility where bargaining over transfers happens after a match is formed.