Immunoassays are widely performed in many fields such as biomarker discovery, proteomics, drug development, and clinical diagnosis. There is a growing need for high sensitivity of immunoassays to detect low abundance analytes. As a result, great effort has been made to improve the quality of surfaces, on which the immunoassay is performed. In this review article, we summarize the recent progress in surface modification strategies for improving the sensitivity of immunoassays. The surface modification strategies can be categorized into two groups: antifouling coatings to reduce background noise and nanostructured surfaces to amplify the signals. The first part of the review summarizes the common antifouling coating techniques to prevent nonspecific binding and reduce background noise. The techniques include hydrophilic polymer based self-assembled monomers, polymer brushes, and surface attached hydrogels, and omniphobicity based perfluorinated surfaces. In the second part, some common nanostructured surfaces to amplify the specific detection signals are introduced, including nanoparticle functionalized surfaces, two dimensional (2D) nanoarrays, and 2D nanomaterial coatings. The third part discusses the surface modification techniques for digital immunoassays. In the end, the challenges and the future perspectives of the surface modification techniques for immunoassays are presented.