Drought is a natural phenomenon which can cause widespread socio-economic and environmental impacts. Recent predictions suggest that drought frequency and intensity will increase in Southern Africa; therefore, there is a need for more scientific information on drought impacts and responses by vulnerable groups such as smallholder farmers. This scoping review examines the current state of research and conceptual insights on the impacts of drought on and responses by smallholder farmers in rural and urban settings in South Africa. We used three bibliographic databases (Scopus, Web of Science, and EBSCOHost) to search for peer-reviewed literature published on South Africa. In total, 18 articles were reviewed, and information on drought impacts and responses among smallholder farmers was analysed and synthesised. Although most of the reviewed papers identified several socio-economic (e.g., loss of livestock, income, and employment) and environmental (e.g., loss of grazing land and vegetation) impacts of drought, the identified impacts were rarely quantified, and there is a lack of analytical depth of these impacts. Smallholder farmers in South Africa implement several drought responses, and these were categorised based on (i) changes in local practices and lifestyles e.g., practising conservation agriculture, (ii) structural measures e.g., government relief programmes, and (iii) technical interventions e.g., rain harvesting. None of the reviewed papers reported on the impacts of and responses to drought on smallholder farmers in urban settings. Overall, the review noted that the literature on drought in South Africa lacks detailed quantification and analysis of drought impacts and responses, the urban drought context is poorly understood, and there is a lack of clarity on the distinction between adaptation and mitigation strategies. Improving our understanding of drought impacts across a rural-urban gradient is important if responses are to effectively reduce smallholder farmer drought vulnerability.