Piezoelectric thick films are of real interest for devices such as ceramic Micro-ElectroMechanical Systems (MEMS) because they bridge the gap between thin films and bulk ceramics. The basic design of MEMS includes electrodes, a functional material, and a substrate, and efforts are currently focused on simplified processes. In this respect, screen-printing combined with a sacrificial layer approach is attractive due to its low cost and the wide range of targeted materials. Both the role and the nature of the sacrificial layer, usually a carbon or mineral type, depend on the process and the final device. First, a sacrificial layer method dedicated to screen-printed thick-film ceramic and LTCC MEMS is presented. Second, the recent processing of piezoelectric thick-film ceramic MEMS using spark plasma sintering combined with a protective layer approach is introduced. Whatever the approach, the focus is on the interdependent effects of the microstructure, chemistry, and strain/stress, which need to be controlled to ensure reliable and performant properties of the multilayer electroceramics. Here the goal is to highlight the benefits and the large perspectives of using sacrificial/protective layers, with an emphasis on the pros and cons of such a strategy when targeting a complex piezoelectric MEMS design.