Ultrasound sensors have been widely used in medical imaging, as well as structural health monitoring (SHM) and non-destructive testing (NDT) in civil and mechanical structures. Covering entire structures and imaging large areas requires multiplexing of many ultrasound sensors with single readout instrument, which can be difficult for traditional piezoelectric transducers. Optical fiber-based sensors offer numerous advantages such as being lightweight, small, the ability to be embedded, immunity to electro-magnetic interference, and the ability to be multiplexed and distributed ultrasound sensors. Fiber ultrasound sensors are regarded as an ideal sensing solution for SHM and NDT, and even most recently for medical imaging due to its broadband ultrasound response and distributed capability. Micro and nanofibers are made smaller than telecom fibers using a wider selection of sensing materials with higher bending capability, which makes them ideal for high frequency (hundreds of MHz) ultrasound detection of micrometer cracks and imaging biological tissues. New optical materials and fabrication techniques are shaping the future with exceptionally small ultrasound sensors and actuators, extending the range of applications in SHM, NDT and medical imaging with higher accuracy and better precision over larger areas.