The nervous system plays a central role in regulating the stem cell niche in many organs and thereby critically modulates development, homeostasis and plasticity. A similarly powerful role for neural regulation of the cancer microenvironment is emerging. Neurons promote the growth of cancers of the brain, skin, prostate, pancreas and stomach. Parallel mechanisms shared in development and cancer suggest that neural modulation of the tumor microenvironment may prove a universal theme, although the mechanistic details of such modulation remain to be discovered for many malignancies. Here, we review what is known about the influences of active neurons on stem cell and cancer microenvironments across a broad range of tissues and discuss emerging principles of neural regulation of development and cancer.