This paper deals with knowledge management (KM) in small and medium enterprises (SMEs). Through a literature review, three research questions have been identified concerning the barriers hindering the spread of KM practices in SMEs, the main knowledge management systems (KMSs) adopted by SMEs and the impact of the use of KM practices on SME performance. The research questions were subsequently addressed through a field analysis conducted on a sample of SMEs. The empirical evidence highlights that the scenario has changed in the space of but a few years. Although SMEs are generally characterized by poor financial and human resources, they are able to overcome the barriers preventing the spread of KM practices. The SMEs investigated perceive the strategic value of KM and consequently adopt a variety of KMSs. Nevertheless, such systems are generally outdated in comparison with cheaper, more recent, and user-friendly applications. Finally, the paper emphasizes that the use of KM practices can contribute to the overall growth of SMEs by simultaneously and significantly enhancing their performance.