The ability of mass spectrometry imaging (MSI) to localize panels of biomolecules in tissues, without prior knowledge of their presence and in a label-free manner, has led to a rapid and substantial impact in clinical and pharmacological research, uncovering biomolecular changes associated with disease and providing low cost imaging of pharmaceuticals. This Feature article will give an introduction to the capabilities and role of MSI in the clinical analysis of patient tissues and discusses those improvements that are necessary for the progression of MSI toward routine clinical application.