Exosomes are small extracellular vesicles derived from parent cells, carrying nucleic acids, proteins, and other biomolecules. Due to their ability to reflect the physiological and pathological states of parent cells in real time, exosomes have significant potential in biomedical applications, including drug delivery, disease diagnosis, and therapeutic interventions. A key step in their application is the efficient separation and purification of exosomes from biological fluids (such as blood, saliva) or cell culture supernatants, ensuring the removal of impurities. Numerous separation techniques, including ultracentrifugation, ultrafiltration, size exclusion chromatography, polymer precipitation, and immunoaffinity capture, have been developed based on the size, density, charge, and composition of exosomes. Although ultracentrifugation is widely regarded as the gold standard for exosome isolation, each method has its advantages and limitations in terms of purity, efficiency, processing capacity, complexity, and convenience. Recently, the combination of different separation methods has emerged as a promising strategy. Moreover, advances in interdisciplinary fields, such as chemistry, materials science, biology, medicine, engineering, and mechanics, have led to the development of innovative separation technologies, including microfluidics, fluid flow-based methods, thermophoresis, lipid-based recognition, and DNA aptamer-based affinity. These novel techniques have substantially improved the efficiency and purity of exosome isolation. In this review, we first offer a comprehensive overview of both traditional and emerging separation methods, the advantages and disadvantages of each method were discussed and summarized. We also illustrate the latest progress and representative work in the exosome separation field. Finally, we put forward our own insights on the future development, including balancing between purity and yield, isolation of specific subpopulations of exosomes, standardization and automation separation and exploration of new separation technologies. We believe that significant breakthroughs in exosome separation will be achieved in the near future, and will contribute to the development of the biomedical applications. We hope this review will be helpful in promoting the development of exosome separation field.