Ionic liquids (ILs) as reaction media, and sonochemistry (US) as activation method, represent separately unconventional approaches to reaction chemistry that, in many cases, generate improvements in yield, rate and selectivity compared to traditional chemistry, or even induce a change in the mechanisms or expected products. Recently, these two technologies have been combined in a range of different applications, demonstrating very significant and occasionally surprising synergetic effects. In this book chapter, the advantages and limitations of the IL/US combination in different chemical applications are critically reviewed in order to understand how, and in which respects, it could become an essential tool of sustainable chemistry in the future. Fundamental aspects and practical considerations of the combination are discussed to better control and demonstrate the brought synergetic effects.