The performance of transducers operating at high frequencies is greatly influenced by the properties of the piezoelectric materials used in their fabrication. Selection of an appropriate material for a transducer is based upon many factors, including material properties, transducer area, and frequency of operation. This review article outlines the major developments in the field of piezoelectrics with emphasis on materials suitable for the design of high frequency medical imaging ultrasonic transducers. Recent developments in the areas of fine grain and thin film ceramics, piezo-polymers, single crystal relaxor piezoelectrics, as well as lead-free and composite materials are discussed.