Perovskite ferroelectrics (PFs) have been the dominant piezoelectric materials for various electromechanical applications, such as ultrasonic transducers, sensors, and actuators, to name a few. In this review article, the development of PF crystals is introduced, focusing on the crystal growth and piezoelectric activity. The critical factors responsible for the high piezoelectric activity of PFs (i.e., phase transition, monoclinic phase, domain size, relaxor component, dopants, and piezoelectric anisotropy) are surveyed and discussed. A general picture of the present understanding on the high piezoelectricity of PFs is described. At the end of this review, potential approaches to further improve the piezoelectricity of PFs are proposed.