The purpose of this scientific work is to determine the role of state support for small and medium-sized enterprises in ensuring sustainable regional development. In the course of the study, existing areas of state support for small and medium-sized businesses were considered, among which guarantees, microloans, loans, subsidies, grants, budget investments were particularly noted. Within the framework of the work, topical problems of the functioning of small and medium-sized businesses were studied, which reflect the need to improve the economic and legal aspects of state support for this sector of the economy. In addition, the study identified the main aspects of the impact of state support on the activities of small and medium-sized enterprises in the context of sustainable regional development, the relationship between the phenomena under consideration was established. The directions of improving state support for small and medium-sized businesses in the context of sustainable regional development were proposed. Conclusions. The existing state support for small and medium-sized enterprises does not have a sufficient level of efficiency, while its increase is necessary not only from the position of direct assistance to small and medium-sized enterprises, but also from the position of ensuring sustainable development of the regions, since small and medium-sized enterprises act as one of the key sources of this development.