Understanding speech in a background of competing noise is challenging, especially for individuals with hearing loss or deficits in auditory processing ability. The ability to hear in background noise cannot be predicted from the audiogram, an assessment of peripheral hearing ability; therefore, it is important to consider the impact of central and cognitive factors on speech-in-noise perception. Auditory processing in complex environments is reflected in neural encoding of pitch, timing, and timbre, the crucial elements of speech and music. Musical expertise in processing pitch, timing, and timbre may transfer to enhancements in speech-in-noise perception due to shared neural pathways for speech and music. Through cognitive-sensory interactions, musicians develop skills enabling them to selectively listen to relevant signals embedded in a network of melodies and harmonies, and this experience leads in turn to enhanced ability to focus on one voice in a background of other voices. Here we review recent work examining the biological mechanisms of speech and music perception and the potential for musical experience to ameliorate speech-in-noise listening difficulties.