Flextensional actuators can be defined as a piezoceramic (or a stack of piezoceramics) connected to a flexible mechanical structure that converts and amplifies the output displacement of the piezoceramic. Essentially, the actuator performance depends on the distribution of stiffness and flexibility in the coupling structure and, therefore, on the coupling structure topology. In this work, we propose a general method for designing flextensional actuators with large output displacement (or generative force) by applying the topology optimization method. The goal is to design a flexible structure coupled to the piezoceramic that maximizes the output displacement (or force) in some specified direction. Static and low frequency applications are considered. To illustrate the implementation of the method, 2-D topologies of flextensional actuators are presented because of the lower computational cost; however, the method can be extended to 3-D topologies. By designing other types of coupling structures connected to the piezoceramic, new designs of flextensional actuators that produce output displacements or forces in different directions can be obtained, as shown. This method can be extended for designing flextensional hydrophones and sonars.