Synthetic self-assembly has long been recognized as an excellent approach for the formation of ordered structures on the nanoscale. Although the development of synthetic self-assembling materials has often been inspired by principles observed in nature (e.g., the assembly of lipids, DNA, proteins), until recently the self-assembly of synthetic molecules has mainly been investigated ex vivo. The past few years however, have witnessed the emergence of a research field in which synthetic, self-assembling systems are used that are capable of operating as bioactive materials in biological environments. Here, this up-and-coming field, which has the potential of becoming a key area in chemical biology and medicine, is reviewed. Two main categories of applications of self-assembly in biological environments are identified and discussed, namely therapeutic and imaging agents. Within these categories key concepts, such as triggers and molecular constraints for in vitro/in vivo self-assembly and the mode of interaction between the assemblies and the biological materials will be discussed.