Bacterial surface fouling is problematic for a wide range of applications and industries, including, but not limited to medical devices (implants, replacement joints, stents, pacemakers), municipal infrastructure (pipes, wastewater treatment), food production (food processing surfaces, processing equipment), and transportation (ship hulls, aircraft fuel tanks). One method to combat bacterial biofouling is to modify the topographical structure of the surface in question, thereby limiting the ability of individual cells to attach to the surface, colonize, and form biofilms. Multiple research groups have demonstrated that micro and nanoscale topographies significantly reduce bacterial biofouling, for both individual cells and bacterial biofilms. Antifouling strategies that utilize engineered topographical surface features with well-defined dimensions and shapes have demonstrated a greater degree of controllable inhibition over initial cell attachment, in comparison to undefined, texturized, or porous surfaces. This review article will explore the various approaches and techniques used by researches, including work from our own group, and the underlying physical properties of these highly structured, engineered micro/nanoscale topographies that significantly impact bacterial surface attachment.