Piezoelectric acoustic transducers enable the mutual conversion between mechanical energy and electrical energy. In recent years, piezoelectric transducers, as efficient and reliable sustainable energy harvesting devices, have demonstrated unique application value in various disciplines such as physics, acoustics, and engineering. This paper comprehensively reviews the current research status and future development directions of acoustic transducers. Firstly, the physical mechanism of the piezoelectric effect is thoroughly analyzed, and the basic operating mode of piezoelectric acoustic transducers is systematically explained. Furthermore, the characteristics and design directions of different types of piezoelectric materials are comprehensively reviewed, with a focus on exploring material innovation approaches to enhance performance. Moreover, various design methods, including layered, integrated, and curved structures, are summarized with emphasis on their crucial roles in improving sensitivity and adaptability. Techniques improving performance were also reviewed. Given the unique nature of piezoelectric effect, the research outlines applications of transducers in sonar systems, structural monitoring systems, and micro-piezoelectric systems. Through the above review, this paper provides profound insights into the research on piezoelectric acoustic transducers, emphasizing in-depth investigations in specific areas. It offers researchers from backgrounds including materials science, acoustics, and electronics different directions, ideas, and methods, thereby promoting innovation in wireless, sensing, and energy fields.