In recent decades, micromachined ultrasonic transducers (MUTs) have been investigated as an alternative to conventional piezocomposite ultrasonic transducers, primarily due to the advantages that microelectromechanical systems provide. Miniaturized ultrasonic systems require ultrasonic transducers integrated with complementary metal-oxide-semiconductor circuits. Hence, piezoelectric MUTs (pMUTs) and capacitive MUTs (cMUTs) have been developed as the most favorable solutions. This paper reviews the basic equations to understand the characteristics of thin-film-based piezoelectric devices and presents recent research on pMUTs, including current approaches and limitations. Methods to improve the coupling coefficient of pMUTs are also investigated, such as device structure, materials, and fabrication techniques. The device structure improvements include multielectrode pMUTs, partially clamped boundary conditions, and 3D pMUTs (curved and domed types), where the latter can provide an electromechanical coupling coefficient of up to 45%. The piezoelectric coefficient (e(31)) can be increased by controlling the crystal texture (seed layer of gamma-Al2O3), using single-crystal (PMN-PT) materials, or control of residual stresses (using SiO2 layer). Arrays of pMUTs can be implemented for various applications including intravascular ultrasound, fingerprint sensors, rangefinders in air, and wireless power supply systems. pMUTs are expected to be an ideal solution for applications such as mobile biometric security (fingerprint sensors) and rangefinders due to their superior power efficiency and compact size.