Modification of native peptides to peptidomimetics is an important goal in medicinal chemistry and requires in many cases the integration of C-acylation steps involving amino acids with peptide synthesis. Many classical C-acylation protocols involving Claisen condensations or the use of ylides are not compatible with peptide synthesis, mostly due to the requirement of strong bases leading to epimerization or deprotection of peptides. Meldrum’s acid as well as several specific phosphorus and sulfur ylides, however, are acidic enough to provide reactive C-nucleophiles at mildly basic conditions tolerated during peptide synthesis. This review provides an overview of peptide-compatible C-acylations of Meldrum´s acid, phosphorus and sulfur ylides and their application in the medicinal chemistry of peptides.