Extracellular vesicles (EVs) from stem cells have therapeutic effects similar to those of stem cells. EVs are used in both preclinical and clinical applications. EV preservation is a core technology employed to facilitate the applications of EVs. The most important issue in the preservation of EVs is to maintain their bioeffects over a long time such that they can be used in treatment. Although EVs are not cells, they contain biomolecules from RNA to proteins that carry information. The preservation process should maintain the structures of such molecules as well as their effects. Current methods of EV preservation include cryopreservation, freeze drying, and spray drying. This chapter reviews current strategies that are used to preserve EVs.