This book is about the roles that financial institutions are expected to play for revitalizing regional economies in Japan, which face several serious problems such as a rapidly aging population as well as a sharp decline in population. The Japanese government expects regional financial institutions to contribute to that revitalization. Actually, Japanese regional financial institutions have made various efforts to support small and medium-sized enterprises (SMEs) to increase their profitability and sustainability. However, the efforts have not yet produced adequate outcomes. To help clarify the reasons for the failures and to offer policy recommendations, the authors used four questionnaires to conduct surveys. They sent the questionnaires to the headquarters of regional financial institutions for Chapter 1 and to the staffs of regional financial institutions for Chapter 2. The government revised the Credit Guarantee System Reform Act in 2017 to promote financial institutionsand credit guarantee corporations in order to proactively support SMEs, so in Chapter 3 the aims of the revised act are explained. Chapter 4 is based on a survey of startups that used the public credit guarantee. Finally, Chapter 5 is based on another, different questionnaire that was sent to SMEs to find out why they failed to improve their risk management and how financial institutions can help them to prepare for disasters. To the best of the authors’ knowledge, these questionnaire studies on regional revitalization have not been carried out elsewhere, making this book unique.