Percutaneous ablation (PA) is a recognized treatment for patients with renal cell carcinoma (RCC) by the American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN), especially for those with T1a RCC (≤4 cm in maximal diameter). When compared with partial nephrectomy for T1a RCC, PA has been shown to have less complications, shorter hospitalizations, and better preservation of renal function. For patients with larger tumors (e.g., T1b RCC (4.1–7 cm)), PA can still be offered for nonsurgical patients; however, recurrence rates are higher with a higher rate of major complications when compared to PA for smaller tumors. Radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation can all be used successfully for PA of RCC. The selection of ablation technology is most often determined by tumor size, tumor location, and operator preferences. While PA of RCC is a generally safe intervention, complications can occur, with hemorrhage being the most common adverse event. With careful planning and patient selection, operators can improve their outcomes.