The p21-activated kinases (PAKs) are serine/threonine protein kinases interacting with small GTPases - Rac and Cdc42. PAKs are found in most eukaryotes and play an evolutionarily conserved role in many cellular processes. Six human PAKs have been identified, and based on homology, they can be classified into two groups. This review focuses specifically on the role of Rac/Cdc42 regulated PAKs in maintaining and remodeling cytoskeletal structure in various organisms. A list of PAKs substrates and binding partners implicated directly and indirectly in cytoskeletal reorganization is presented. Also perturbations of the Rac/Cdc42/PAK pathway leading to tumorigenesis and neurodegenerative diseases are reviewed.