The precise spatial patterning of living cells represents a foundational capability in bio-systems engineering, enabling the systematic study of collective cellular behaviours and the fabrication of increasingly complex functional tissues. Conventional methods for achieving this control, while numerous, are often constrained by static pattern formation, the need for biochemical labels that can alter cell function, or requirements for non-physiological media. In this context, acoustic-field-based manipulation has emerged as a uniquely powerful and biocompatible alternative. This review synthesizes these advancements under the unifying concept of Acoustic Lithography, a framework that captures the technology’s capacity for rapid, parallel and label-free cellular organization. The discussion covers the core physical principles of acoustic radiation force and streaming before surveying the diverse technological landscape, from bulk and surface acoustic waves to advanced acoustic holography. It further illuminates the impact of these tools across a spectrum of applications, including high-throughput analysis, biomimetic co-culture engineering, advanced biofabrication and clinical sorting. Collectively, these applications demonstrate the field’s trajectory, moving beyond static patterning to encompass the integrated control of structure, environment and function. Viewing the technology through this broader engineering lens underscores its significance as a vital platform, charting a course for the next generation of dynamically engineered living systems.