There is an enormous diversity in the number and uses of sprays in the medical community, from disinfectant strategies, drying and coating technologies, as well as target delivery of therapeutic agents to the human body. The number and range of strategies for forming these sprays is almost as varied, but in every application the droplet size distribution, particle velocity, impact dynamics, and hydrodynamic environment contribute immensely to achieving the specific performance parameters. As a result, therapeutic sprays have had difficulty fully achieving the envisioned potential. The following review article will reflect specifically on medical sprays for drug delivery to specific organs (i.e., lung, nasal, ocular, and skin) to review the current state of capabilities, but also comment on specific gaps in ability and knowledge. Our objective is to stimulate a discussion within the spray community that will result in heightened interest directed toward improved performance and efficacy.