The piezoelectric direct discharge (PDD) is a comparatively new type of atmospheric pressure gaseous discharge for production of cold plasma. The generation of such discharge is possible using the piezoelectric cold plasma generator (PCPG) which comprises the resonant piezoelectric transformer (RPT) with voltage transformation ratio of more than 1000, allowing for reaching the output voltage >10 kV at low input voltage, typically below 25 V. As ionization gas for the PDD, either air or various gas mixtures are used. Despite some similarities with corona discharge and dielectric barrier discharge, the ignition of micro-discharges directly at the ceramic surface makes PDD unique in its physics and application potential. The PDD is used directly, in open discharge structures, mainly for treatment of electrically nonconducting surfaces. It is also applied as a plasma bridge to bias different excitation electrodes, applicable for a broad range of substrate materials. In this review, the most important architectures of the PDD based discharges are presented. The operation principle, the main operational characteristics and the example applications, exploiting the specific properties of the discharge configurations, are discussed. Due to the moderate power achievable by PCPG, of typically less than 10 W, the focus of this review is on applications involving thermally sensitive materials, including food, organic tissues, and liquids.