Polyurethane (PU)/acrylic hybrid dispersions are an important class of polymeric dispersions that are produced on an industrial scale. In this review, we detail the design and synthesis of PU/acrylic dispersions, with a particular focus on how the structure of the hybrid can be tuned toward commercial applications. After a brief introduction, we describe the building blocks used in each polymer and their role in the synthesis/application of the final dispersion. Subsequently, we discuss the range of procedures that have been developed for the synthesis of such hybrids and how the structure of the hybrids influences the physical properties of films cast from the dispersion. Finally, we highlight commercial applications of PU/acrylic hybrids, with a focus on potential future developments.