Aligning Information Technology (IT) with business strategies is crucial for improving operational efficiency, innovation, and competitiveness, particularly in small and medium-sized enterprises (SMEs). However, SMEs face unique challenges in achieving this alignment due to limited resources, technical expertise, and a rapidly changing technological landscape. This systematic review aims to assess the achievements and challenges of IT-business alignment in SMEs from 2014 to 2024, with a focus on the impact of emerging technologies such as Artificial Intelligence (AI), the Internet of Things (IoT), and blockchain. A systematic search of Google Scholar, Web of Science, and Scopus databases identified 63 relevant papers. Studies were selected based on their relevance to IT-business alignment in SMEs, and both quantitative and qualitative data were extracted and analyzed to identify key trends, achievements, and challenges. The review found that 74% of SMEs reported improved operational efficiency and 68% experienced enhanced innovation opportunities due to effective IT-business alignment. However, 59% of SMEs identified resource limitations as a significant barrier, while 45% highlighted a lack of technical expertise. Additionally, 35% of SMEs faced organizational resistance to change. Emerging technologies such as AI and IoT contributed positively to IT alignment in 60% of cases, though 30% of SMEs noted challenges related to cybersecurity and skills gaps. IT-business alignment is essential for SMEs to enhance productivity and remain competitive in a dynamic technological environment. While the integration of emerging technologies shows promise, SMEs continue to face significant barriers, including resource constraints and technical skills shortages. Tailored frameworks, industry-specific policies, and targeted training programs are needed to help SMEs overcome these challenges. Future research should investigate the long-term impacts of IT-business alignment and explore strategies to increase its accessibility and effectiveness.