Global wastewater production exceeds 359 billion m³ annually, of which only 52% is treated, mostly in expensive and resource-consuming processes. Microbial electrochemical technologies (METs) offer a transformative approach to sustainable wastewater management by converting waste into valuable resources such as energy, clean water, and nutrients. They present a viable solution to the United Nations’ Sustainable Development Goal 6 (to ensure access to water and sanitation for all) by enhancing both sanitation and resource recovery. METs, including microbial fuel cells (MFCs) and microbial electrolysis cells (MECs), harness electrogenic microorganisms to oxidize organic matter, generating electric energy or producing energy carriers like hydrogen and methane. METs also enable recovery of nutrients, such as ammonium and phosphates, which are essential for agriculture, thereby closing resource loops in a circular economy. Despite their potential, challenges remain in scaling up METs for widespread application. Pilot-scale MFCs and MECs have demonstrated feasibility, achieving up to 90% chemical oxygen demand removal and producing electric power, methane, or hydrogen from wastewater. However, high capital costs, material limitations, and energy efficiency barriers hinder commercialization. Innovations in electrode design, modular configurations, and integration with existing wastewater treatment processes (e.g., anaerobic digestion, membrane bioreactors, or constructed wetlands) are advancing METs toward higher technology readiness levels (TRLs 4–8). Field applications, like a system for urine-based electricity generation in underserved regions, highlight METs adaptability and societal impact. The transition from laboratory to real-world implementation requires scaling, process integration, and further optimization to reduce costs and improve performance. By aligning with circular economy principles, METs can transform wastewater into a resource, contributing to energy security, environmental sustainability, and global sanitation goals. Future research should focus on scalable designs, economic viability, and interdisciplinary collaboration alongside understanding and optimizing the microbial “black box” to enable METs to transform previously unused wastewater streams into valuable resources with targeted applications.