Small and medium enterprises (SMEs) contribute to innovation, employment creation, and economic development. To do this, they work with various organizations to extend their internal resources and capabilities and thus scale their efforts. Often missing from these collaborators are university partners. In this paper, we conduct a systematic literature review to present a comprehensive and up-to-date understanding of the extant literature on SME-university collaboration. The review covers 128 peer-reviewed publications from 1981 to 2023, highlighting the diversity of SME-university collaboration research regarding journal outlets, time of publication, methodologies, empirical contexts, theoretical lenses, and themes. We propose an overarching conceptual framework for theorizing SME-university collaborations and organize the field across three paradigmatic logics using the framework: technology transfer, knowledge co-development, and value co-creation. We combine these to articulate theoretical and policy implications and present a future research agenda.