Radiometal nuclides can serve as diagnostic markers in molecular imaging or can be used in therapeutic settings for a rising number of human afflictions. For the targeted delivery of these medically interesting ions, appropriate chelating agents forming stable complexes are of fundamental importance. For different metal ions exhibiting different physical and chemical properties, resulting in different coordination chemistries and therefore differing requirements on the chelator used, a broad variety of chelating agents has been developed over the years. Not only the chemical properties of the metal ion determine the choice of the chelator, but also the desired in vivo behavior of the resulting molecular imaging or therapeutic compound influences the choice of the complexation agent. Furthermore, the conjugation chemistry for the introduction of the chelator into the biologically active compound and the complexation reaction of the metal ion can affect the choice of the appropriate chelator. This review outlines chelating agents used in medicinal chemistry, their radiometal complexation behavior and their potential influence on the properties of the resulting drugs.