Sodium salt is a pivotal ingredient in traditional fermented foods, but its excessive consumption adversely affects human health, product quality, and production efficiency. Therefore, reducing sodium salt content in traditional fermented foods and developing low-sodium fermented foods have attracted increasing attention. Given the essential role of sodium salt in the safety and quality of fermented foods, appropriate approaches should be applied in the production of low-sodium fermented foods. In this review, the challenges of sodium reduction in traditional fermented foods are presented, including the possible growth of pathogenic bacteria, the formation of hazardous chemicals, flavor deficiency, and texture deterioration. Physical, chemical, and biological strategies are also discussed. This review provides references for improving the quality and safety of low-sodium fermented foods.