Schwann cell-derived exosomes are powerful promoters of nerve repair, capable of enhancing axon regrowth, remyelination, and functional recovery in numerous models. These effects are mediated via multifactorial cargo (miRNAs, mRNAs, proteins) that modulate neurons, glia, endothelial, and immune cells. Importantly, what began as a novel biological insight is now rapidly moving toward therapeutic innovation. Schwann cell-derived exosomes thus represent both a novel mode of glia–neuron communication and a promising avenue for next-generation therapies for nerve regeneration.