Despite China’s position as a global mining powerhouse, tens of thousands of small- and medium-sized mines (SM mines) within the country continue to pose potential safety hazards and environmental pollution risks. Only through the identification of suitable development paths can these mines improve their economic and environmental benefits, ultimately driving significant progress in China’s mining industry. Backfill mining, an environmentally friendly mining method, has emerged as a viable solution, offering the potential to ensure mining safety, reduce environmental pollution stemming from tailings stockpiles, and enhance ore resource recovery. This review article aims to provide researchers and readers with a comprehensive understanding of the current situation and challenges faced by SM mines in China. It explores the mining processes, technologies, and equipment commonly employed by these mines while addressing the specific problems and challenges they encounter. Furthermore, the article offers recommendations to guide the future development of SM mines. Additionally, the review examines the prospects and potential applications of backfill mining methods within the context of SM mines in China, emphasizing their role in promoting sustainable mining practices, environmental protection, and waste utilization. Ultimately, this comprehensive review article serves as a valuable resource, stimulating discourse and encouraging experts and scholars to further explore the unique challenges and opportunities associated with SM mines. By highlighting the significance of green mining practices, environmental protection, backfill mining, and waste utilization, the article aims to inspire innovative solutions and foster sustainable practices within the Chinese mining industry.