Development of a multicellular organism from a fertilized egg depends on a precise balance between symmetric cell divisions to expand the pool of similar cells, and asymmetric cell divisions to create cell-type diversity. Spindle orientation can influence the generation of symmetric or asymmetric cell fates depending on how it is coupled to cell-intrinsic polarity cues, or how it is positioned relative to cell-extrinsic cues such as niche-derived signals. In this review, we describe the mechanism of spindle orientation in budding yeast, Drosophila melanogaster, Caenorhabditis elegans and mammalian neural progenitors, with the goal of highlighting conserved mechanisms and indicating open questions for the future.