Multimedia content distribution is a key technique for multimedia services, which transmits multimedia content from a sender to certain receiver(s). With the popularity of multimedia services, the trust issues in content distribution becomes urgent, including the authorized access, privacy protection, trusted payment, piracy surveillance, and so forth. This chapter introduces the trust issues in multimedia content distribution (e.g., authorization, authentication, privacy, payment, ownership, illegal distribution, forgery, etc.), reviews the latest research progress of the solutions, and presents some open issues and promising research topics. It is expected to provide valuable information to researchers or engineers in this field.