The development of new antimicrobial packaging systems to preserve fresh and minimally processed fruits and vegetables is a technological challenge for the industry and a very active research field worldwide. Studies cover the use of conventional modified atmosphere packaging (MAP), innovative MAP such as the use of pressurized inert/noble gases, high levels of O2, or antimicrobial agents that are incorporated into the packaging system. Among the active ingredients used in the design of novel antimicrobial packaging systems, compounds such as plant essential oils, food aromas, organic acids and their salts, parabens, or chitosan have been preferred for horticultural commodities. Metal and metal oxide nanomaterials such as silver (Ag), gold (Au), zinc oxide (ZnO), silica (SiO2), titanium dioxide (TiO2), alumina (Al2O3), or iron oxides (Fe3O4, Fe2O3) stand for a new generation of antimicrobial packaging ingredients expected to provide more affordable and safe food packaging solutions in the near future. This chapter reviews the current state of the art on the types of antimicrobial packaging systems and their effect on the overall quality of fresh and fresh-cut fruits and vegetables.