In this monograph, the authors reports the current advancement in high frequency piezoelectric crystal micromachined ultrasound transducers and arrays and their biomedical applications. Piezoelectric ultrasound transducers operating at high frequencies (> 20 MHz) are of increasing demand in recent years for medical imaging and biological particle manipulation involved therapy. The performances of transducers greatly rely on the properties of the piezoelectric materials and transduction structures, including piezoelectric coefficient (d), electromechanical coupling coefficient (k), dielectric permittivity (e) and acoustic impedance (Z). Piezo-composite structures are preferred because of their relatively high electromechanical coupling coefficient and low acoustic impedance. A number of piezo-composite techniques have been developed, namely “dice and fill,” “tape-casting,” “stack and bond,” “interdigital phase bonding,” “laser micromachining” and “micro-molding”. However, these techniques are either difficult to achieve fine features or not suitable for manufacturing of high frequency ultrasound transducers (> 20 MHz). The piezo-composite micromachined ultrasound transducers (PC-MUT) technique discovered over the last 10 years or so has demonstrated high performance high frequency piezo-composite ultrasound transducers. In this monograph, piezoelectric materials used for high frequency transducers is introduced first. Next, the benefits and theory of piezo composites is presented, followed by the design criteria and fabrication methods. Biomedical applications using piezo composites micromachined ultrasound transducers (PC-MUT) and arrays will also be reported, in comparison with other ultrasound transducer techniques. The final part of this monograph describes challenges and future perspectives of this technique for biomedical applications.