Extracellular vesicles (EVs), including exosomes, have inherent homing ability in damage repair and drug delivery. However, they have poor targeting and low enrichment efficiency and are easily internalized/cleared by monocyte phagocyte system. If the targeting ability of exosomes can be improved through a series of means, better use can be made of the advantages of exosome therapy and drug delivery. It is necessary to ensure a certain retention rate to study signal pathways and potential mechanisms, especially in flowing blood. This article mainly reviews the research progress of specific targeting based on exosomes, including intrinsic targeting, enhanced targeting, and drug delivery. Inherent targeting is mainly analyzed from different cell sources, and enhanced targeting is mainly from ligand modification and the application of nano materials to improve the targeting ability. To be successfully applied in clinical practice, many problems and challenges still need to be faced in exosome therapy. Herein, the latest knowledge of using EVs as a natural delivery system for disease treatment is summarized.