The negative‐ion mode of electrospray ionization mass spectrometry (ESI‐MS) is intrinsically less sensitive than the positive‐ion mode. The detection and quantitation of anions can be performed in positive‐ion mode by forming specific ion‐pairs during the electrospray process. The paired‐ion electrospray ionization (PIESI) method uses specially synthesized multifunctional cations to form positively charged adducts with the anions to be analyzed. The adducts are detected in the positive‐ion mode and at higher m/z ratios to produce excellent signal‐to‐noise ratios and limits of detection that often are orders of magnitude better than those obtained with native anions in the negative‐ion mode. This review briefly summarizes the different analytical approaches to detect and separate anions. It focuses on the recently introduced PIESI method to present the most effective dicationic, tricationic, and tetracationic reagents for the detection of singly and multiply charged anions and some zwitterions. The mechanism by which specific structural molecular architectures can have profound effects on signal intensities is also addressed. © 2015 Wiley Periodicals, Inc. Mass Spec Rev 35:201–218, 2016.