Natural asphalts (NAs) can be an economical and environmental alternative in pavement construction. Most studies have investigated them as binder and asphalt mixture modifiers due to their high compatibility with conventional asphalts. In this article, some of the studies carried out on the use of NA in pavements are summarized and described in a chronological order. The main aspects described in the reviewed studies were the type of asphalt binder or modified mixture, the type and content of the modifier, the manufacturing processes of the asphalt or modified mixture, tests performed, and main results or conclusions. In general terms, NAs show better performance as binder and asphalt mixture modifiers in high-temperature climates. Additionally, they tend to improve water and ageing resistance. As main limitations, it is reported that NAs tend to negatively affect the workability and performance of asphalt mixtures in low-temperature climates. Finally, recommendations for future study topics are provided at the end of this paper.