Multi-principal element alloys (MPEAs) have attracted rapidly growing attention from both research institutions and industry due to their unique microstructures and outstanding physical and chemical properties. However, the fabrication of MPEAs with desired microstructures and properties using conventional manufacturing techniques (e.g., casting) is still challenging. With the recent emergence of additive manufacturing (AM) techniques, the fabrication of MPEAs with locally tailorable microstructures and excellent mechanical properties has become possible. Therefore, it is of paramount importance to understand the key aspects of the AM processes that influence the microstructural features of AM fabricated MPEAs including porosity, anisotropy, and heterogeneity, as well as the corresponding impact on the properties. As such, this review will first present the state-of-the-art in existing AM techniques to process MPEAs. This is followed by a discussion of the microstructural features, mechanisms of microstructural evolution, and the mechanical properties of the AM fabricated MPEAs. Finally, the current challenges and future research directions are summarized with the aim to promote the further development and implementation of AM for processing MPEAs for future industrial applications.