X-ray scintillators, materials that convert high-energy radiation into detectable light in the ultraviolet to visible spectrum, are widely used in industrial and medical applications. Organic and organic-inorganic hybrid systems have emerged as promising alternatives for X-ray detection and imaging due to their mechanical flexibility, lightweight, tunable excited states, and solution processability for large-scale fabrication. However, these systems often suffer from weak X-ray absorption and insufficient exciton utilization, which seriously affects their scintillation performance, limiting their potential for broader application and commercialization. This review highlights recent advances in molecular engineering for developing high-performance X-ray scintillators. Itfocuses on molecular design principles, such as the heavy atom effect, donor-acceptor/host-guest strategies, hydrogen/halogen bonding, molecular sensitization, and crystal packing, for enhancing scintillation performance. By leveraging these approaches, researchers have made significant strides in improving X-ray scintillation efficiency and advancing the potential of these materials for commercial applications.