Microelectromechanical systems (MEMS) have an unmatched ability to incorporate numerous functionalities into ultra-compact devices, and due to their versatility and miniaturization, MEMS have become an important cornerstone in biomedical and endoscopic imaging research. To incorporate MEMS into such applications, it is critical to understand underlying architectures involving choices in actuation mechanism, including the more common electrothermal, electrostatic, electromagnetic, and piezoelectric approaches, reviewed in this paper. Each has benefits and tradeoffs and is better suited for particular applications or imaging schemes due to achievable scan ranges, power requirements, speed, and size. Many of these characteristics are fabrication-process dependent, and this paper discusses various fabrication flows developed to integrate additional optical functionality beyond simple lateral scanning, enabling dynamic control of the focus or mirror surface. Out of this provided MEMS flexibility arises some challenges when obtaining high resolution images: due to scanning non-linearities, calibration of MEMS scanners may become critical, and inherent image artifacts or distortions during scanning can degrade image quality. Several reviewed methods and algorithms have been proposed to address these complications from MEMS scanning. Given their impact and promise, great effort and progress have been made toward integrating MEMS and biomedical imaging.