We present a theory for Coulomb drag between two mesoscopic systems which expresses the drag in terms of scattering matrices and wave functions. The formalism can be applied to both ballistic and disordered systems and the consequences can be studied either by numerical simulations or analytic means such as perturbation theory or random matrix theory. The physics of Coulomb drag in the mesoscopic regime is very different from Coulomb drag between extended electron systems. In the mesoscopic regime we in general find fluctuations of the drag comparable to the mean value. Examples are vanishing average drag for chaotic 2D-systems and dominating fluctuations of drag between quasi-ballistic wires with almost ideal transmission.