The demand for sustainable energy sources to power small electronics like IoT devices has led to exploring innovative solutions like acoustic energy harvesting using piezoelectric nanogenerators (PENGs). Acoustic energy harvesting leverages ambient noise, converting it into electrical energy through the piezoelectric effect, where certain materials generate an electric charge in response to mechanical stress or vibrations. This review paper provides a comprehensive analysis of the advancements in PENG technology, emphasizing their role in acoustic energy harvesting. We begin by discussing the essential principles of piezoelectricity and the design considerations for nanogenerators to optimize energy capture from sound waves. The discussion includes a detailed examination of various piezoelectric materials, such as polyvinylidene fluoride (PVDF), lead zirconate titanate (PZT), and zinc oxide (ZnO) nanowires, which are known for their superior piezoelectric properties. A critical aspect of this review is the exploration of innovative structural designs and resonance devices that enhance the efficiency of PENGs. We delve into the mechanisms and benefits of using Helmholtz resonators, quarter-wavelength tubes, and cantilever beams, which are instrumental in amplifying acoustic signals and improving energy conversion rates. Each device’s design parameters and operational principles are scrutinized to highlight their contributions to the field. The review addresses practical applications of PENGs in various domains. Environmental monitoring systems, wearable electronics, and medical devices stand to benefit significantly from the continuous and sustainable power supplied by PENGs. These applications can reduce reliance on batteries and minimize maintenance by harnessing ambient acoustic energy, leading to more efficient and longer-lasting operations. Despite the promising potential of PENGs, several challenges remain, including material degradation, efficiency limitations, and integrating these devices into existing technological frameworks. This paper discusses these obstacles in detail and proposes potential solutions to enhance the longevity and performance of PENG systems. Innovations in material science and engineering are crucial to overcoming these hurdles and realizing the full potential of acoustic energy harvesting.