Silicon and germanium nanocrystals (NCs) are attractive materials owing to their unique size and surface‐dependent optical properties. The optical properties of silicon and germanium NCs make them highly suitable for a range of applications, including bioimaging, light‐emitting diodes, and solar cells. In this review, the solution synthesis, surface passivation, optical properties, biomedical applications, and cytotoxicity of silicon and germanium NCs are compared and contrasted. Over the last 10 years, synthetic protocols have improved considerably, with size control readily achieved. Investigations have begun into a range of silicon and germanium nanostructures, including doped, alloy, and metal–semiconductor hybrid NCs, which represent the next generation of silicon and germanium nanomaterials. Silicon and germanium NCs are actively researched for a wide array of biomedical applications, including, long‐term in vivo cellular imaging, fluorescent nanocarriers for drug delivery, and as contrast agents for magnetic resonance imaging (MRI). Cytotoxicity studies have shown the low toxicity of Si NCs, while demonstrating that Ge NCs are less toxic than CdSe NCs at similar concentrations, giving these materials a strong future in nanomedicine applications.