Monte Carlo simulation methods are especially useful in studying a variety of problems difficult to calculate by experimental or analytical approaches. Nowadays, they are extensively applied to simulate nuclear medicine instrumentations such as single photon emission computed tomography (SPECT) and positron emission tomography (PET) for assisting system design and optimizing imaging and processing protocols. The goal of this paper is to address the practical issues, a potential user of Monte Carlo simulations for nuclear medicine can encounter, to help them to choose a code. This review introduces the different types of Monte Carlo codes currently available for nuclear medicine, comments main features and properties for a code to be proper for a given purpose, and discusses current research trends in Monte Carlo codes. (Nucl Med Mol Imaging 2008;42(2):127-136)