Management accounting in small and medium-sized enterprises (SMEs) has been an issue of growing interest in the management accounting literature in recent years. However, published research is fragmented, spanning various fields such as accounting, small business and entrepreneurship, general management, and production and operations management. This paper aims to synthesize extant knowledge on management accounting in SMEs and provide concrete suggestions on how to proceed. We performed a systematic literature review, synthesized the results, and identified research gaps. Our findings show that usage of management accounting is not only lower but also different in SMEs compared to larger entities. Based on a comparison of SMEs, the review explains how environmental, staff, and organizational factors significantly influence the organization of management accounting in SMEs and that SME performance in general benefits from proper management accounting. We conclude with several concrete research questions and opportunities.