Predictive health monitoring of structural components will require the development of advanced sensing techniques capable of providing quantitative information on the damage state of structural materials. By focusing on nonlinear acoustic techniques, it is possible to measure absolute, strength based material parameters that can then be coupled with uncertainty models to enable accurate and quantitative life prediction. Starting at the material level, this review will present current research that involves a combination of sensing techniques and physics-based models to characterize damage in metallic materials. In metals, these nonlinear ultrasonic measurements can sense material state, before the formation of micro- and macro-cracks. Typically, cracks of a measurable size appear quite late in a component's total life, while the material's integrity in terms of toughness and strength gradually decreases due to the microplasticity (dislocations) and associated change in the material's microstructure. This review focuses on second harmonic generation techniques. Since these nonlinear acoustic techniques are acoustic wave based, component interrogation can be performed with bulk, surface and guided waves using the same underlying material physics; these nonlinear ultrasonic techniques provide results which are independent of the wave type used. Recent physics-based models consider the evolution of damage due to dislocations, slip bands, interstitials, and precipitates in the lattice structure, which can lead to localized damage.