Nanostructures play important roles in vivo, where nanoscaled features of extracellular matrix (ECM) components influence cell behavior and resultant tissue formation. This review summarizes some of the recent developments in fostering new concepts and approaches to nanofabrication, such as top-down and bottom-up and combinations of the two. As in vitro investigations demonstrate that man-made nanotopography can be used to control cell reactions to a material surface, its potential application in implant design and tissue engineering becomes increasingly evident. Therefore, we present recent progress in directing cell fate in the field of cell mechanics, which has grown rapidly over the last few years, and in various tissue-engineering applications. The main focus is on the initial responses of cells to nanostructured surfaces and subsequent influences on cellular functions. Specific examples are also given to illustrate the potential nanostructures may have for biomedical applications and regenerative medicine.