Piezoresistive materials, materials whose resistivity properties change when subjected to mechanical stresses, are widely utilized in many industries as sensors, including pressure sensors, accelerometers, inclinometers, and load cells. Basic piezoresistive sensors consist of piezoresistive devices bonded to a flexible structure, such as a cantilever or a membrane, where the flexible structure transmits pressure, force, or inertial force due to acceleration, thereby causing a stress that changes the resistivity of the piezoresistive devices. By applying a voltage to a piezoresistive device, its resistivity can be measured and correlated with the amplitude of an applied pressure or force. The performance of a piezoresistive sensor is closely related to the design of its flexible structure. In this research, we propose a generic topology optimization formulation for the design of piezoresistive sensors where the primary aim is high response. First, the concept of topology optimization is briefly discussed. Next, design requirements are clarified, and corresponding objective functions and the optimization problem are formulated. An optimization algorithm is constructed based on these formulations. Finally, several design examples of piezoresistive sensors are presented to confirm the usefulness of the proposed method.