Salt (sodium chloride, NaCl) is a vital ingredient in fermented foods, which affects their safety, texture, and flavor characteristics. Recently, the demand for reduced-sodium fermented foods has increased, as consumers have become more health-conscious. However, reducing sodium content in fermented foods may negatively affect flavor perception, which is a critical quality attribute of fermented foods for both the food industry and consumers. This review summarizes the role of salt in the human body and foods and its role in the flavor perception of fermented foods. Current sodium reduction strategies used in the food industry mainly include the direct stealth reduction of NaCl, substituting NaCl with other chloride salts, and structure modification of NaCl. The odor-induced saltiness enhancement, application of starter cultures, flavor enhancers, and non-thermal processing technology are potential strategies for flavor compensation of sodium-reduced fermented foods. However, reducing sodium in fermented food is challenging due to its specific role in flavor perception (e.g., promoting saltiness and volatile compound release from food matrices, inhibiting bitterness, and changing microflora structure). Therefore, multiple challenges must be addressed in order to improve the flavor of low-sodium fermented foods. Future studies should thus focus on the combination of several strategies to compensate for the deficiencies in flavor resulting from sodium reduction.