Transdermal drug delivery is limited by the barrier function of the stratum corneum, which restricts the penetration of many therapeutic agents, whereas hypodermic injection provides efficient drug delivery but is associated with pain and reduced patient acceptability. Microneedle (MN) systems have therefore been investigated as a minimally invasive approach to overcome the stratum corneum and facilitate drug delivery into the skin. Among the materials used for MN fabrication, natural polysaccharides have attracted considerable attention because of their biocompatibility, biodegradability, aqueous processability, and diverse physicochemical properties. In addition, several polysaccharides, including chitosan, hyaluronic acid, and alginate, possess biological properties that may contribute to antimicrobial activity, tissue regeneration, or hemostasis. This review summarizes recent advances in natural polysaccharide-based MN systems, with emphasis on MN types, fabrication methods, material properties, and pharmaceutical applications. Dissolving, hydrogel-forming, and coated MNs are discussed together with fabrication approaches including micromolding, spray coating, and 3D/4D printing. The characteristics and representative applications of hyaluronic acid, chondroitin sulfate, starch, chitosan, cellulose derivatives, alginate, pullulan, dextran, and Bletilla striata polysaccharide are reviewed, including their use in insulin delivery, vaccination, cancer therapy, dermatological treatment, and wound healing. Finally, current challenges related to mechanical strength, dissolution behavior, drug loading and uniformity, raw-material variability, moisture sensitivity, manufacturing scalability, and regulatory translation are discussed. Further development of standardized evaluation methods and reproducible manufacturing processes will be important for the pharmaceutical translation of natural polysaccharide-based MN systems.