Sensorineural hearing loss is the most common type of permanent hearing loss. Most people with sensorineural hearing loss experience challenges with hearing in noisy situations, and this is the primary reason they seek help for their hearing loss. It also remains an area where hearing aid users often struggle. Directionality is the only hearing aid technology—in addition to amplification—proven to help hearing aid users hear better in noise. It amplifies sounds (sounds of interest) coming from one direction more than sounds (“noise”) coming from other directions, thereby providing a directional benefit. This book chapter describes the hearing-in-noise problem, natural directivity and hearing in noise, directional microphone systems, how directionality is quantified, and its benefits, limitations, and other clinical implications.