AbstractSensitive and accurate detection of small molecules from complex matrix has aroused increasing interest in many fields, yet remains an open challenge. Recent years have witnessed a considerable advance of aptasensors for diagnostic assay development towards diverse small molecules because aptamer is one of the most powerful classes of molecular receptors with advanced affinity and specificity. Herein, we reviewed the small‐molecule aptasensors in the past five years, focusing on the principles to specific applications in clinical diagnosis, food safety, and environmental monitoring. The first introductory section on the development of aptasensors in historical view and its analytical features contextualizes essential health‐related small molecules. The second part highlights the basic components of aptasensor and the detection principles of different sensors based on signal output modes. The subsequent part systematically discusses various small‐molecule sensing platforms by interfacing aptamers with diverse signal amplification strategies. Finally, challenges and perspectives for improving the aptasensor performance are also discussed. By describing biochemical and analytical procedures, this review highlights the optimal use of aptamers in the detection, quantification, and imaging of important health‐related small molecules and presents new insights, technical advances, and engineering strategies for practical applications.