An ultrasound-aided deep rolling process (UADR) for anti-fatigue applications was developed and used for surface enhancement of titanium alloy specimens. The rotating bending fatigue test was performed for the UADR-treated and untreated fatigue specimens. Fractography of the fatigue-fractured specimens was investigated via scanning electronic microscopy (SEM). Surface and subsurface residual stress distributions after UADR treatment were measured by X-ray diffraction method. Surface morphology and roughness were observed and measured via SEM micrograph and a Talysurf roughness tester, respectively. The results showed that a deep layer of residual compressive stress developed and surface roughness was reduced after UADR treatment. Fatigue strength of the titanium alloy specimens was substantially improved. The fractographic examination of the fatigue-fractured specimens showed that the UADR-treated specimens developed finer fatigue striations than the untreated specimen.