There is a growing interest internationally to use more biomass for power generation, given the potential for significant environmental benefits and long-term fuel sustainability. However, the use of biomass alone for power generation is subject to serious challenges, such as feedstock supply reliability, quality, and stability, as well as comparative cost, except in situations in which biomass is locally sourced. In most countries, only a limited biomass supply infrastructure exists. Alternatively, co-firing biomass along with coal offers several advantages; these include reducing challenges related to biomass quality, buffering the system against insufficient feedstock quantity, and mitigating the costs of adapting existing coal power plants to feed biomass exclusively. There are some technical constraints, such as low heating values, low bulk density, and grindability or size-reduction challenges, as well as higher moisture, volatiles, and ash content, which limit the co-firing ratios in direct and indirect co-firing. To achieve successful co-firing of biomass with coal, biomass feedstock specifications must be established to direct pretreatment options in order to modify biomass materials into a format that is more compatible with coal co-firing. The impacts on particle transport systems, flame stability, pollutant formation, and boiler-tube fouling/corrosion must also be minimized by setting feedstock specifications, which may include developing new feedstock composition by formulation or blending. Some of the issues, like feeding, co-milling, and fouling, can be overcome by pretreatment methods including washing/leaching, steam explosion, hydrothermal carbonization, and torrefaction, and densification methods such as pelletizing and briquetting. Integrating formulation, pretreatment, and densification will help to overcome issues related to physical and chemical composition, storage, and logistics to successfully co-fire higher percentages of biomass (>40%) with coal.