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Energy efficiency is a key factor to meet the ambitious climate targets of the European Union (EU) aligned with the international policy directives. On their own, Small and Medium-sized Enterprises (SMEs) do not consume big amounts of energy, but taking into consideration that they represent about 99% of businesses worldwide, their cumulative energy consumption is remarkable. Even though SMEs experience several barriers in their effort to improve their energy efficiency, their contribution to the EU’s energy efficiency improvement targets is crucial through the implementation of measures to improve their energy footprint. The purpose of this paper is to present a comprehensive review of SMEs’ energy efficiency and energy footprint management, which has been carried out in the context of the “SMEnergy—Energy Footprint Management for SMEs” EU-funded Erasmus+ project. The correlation between energy conversion and consumption processes and energy efficiency, as well as the current situation of energy footprint management and energy management systems in SMEs, are discussed in detail. Moreover, successful case studies of SMEs that have implemented specific measures to improve their energy footprint and achieve energy efficiency targets are also included. It is highlighted that SMEs exhibit a high potential for energy efficiency enhancement that could directly promote climate change mitigation and sustainable development.