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Firms are affected by resources access, capability and unfavourable business environment, but there is little research on how institutions affect small and medium enterprises (SMEs) internationalisation process in developing countries. Drawing on institutional theory, this chapter reviews the variety of institutions (internal and external barriers) and how it affects SMEs’ internationalisation process in the developing world. First, it explores the stages of internationalisation, modes of entry and benefits of internationalisation. Second, it explains the Cultural, Administrative, Geographic and Economic (CAGE framework) distances and theories of internationalisation. Third, it examines the evidence on the role of government in promoting SMEs and drivers of internationalisation. These have significant practical and policy implications, especially for policymakers that are concerned with business reforms and ease of doing business.