The post-treatment of soft and desalinated waters is an integral step in the production of quality drinking water. Remineralization is therefore often essential in order to stabilize the effluent for distribution and to attain mineral levels that fulfill aesthetic and health goals. According to the World Health Organization, magnesium (Mg²⁺) is a nutrient essential to human health. This review summarizes the effectiveness of magnesium oxide (MgO) media for soft water remineralization, as well as its potential for divalent metal removal (e.g., Mn, Cu, and Zn), which is of particular interest in small or residential applications. We present MgO sources, properties, and dissolution mechanisms. Water treatment applications are then reviewed, and the available design models are critically appraised in regard to remineralization and contaminant removal processes. In addition, we review the process operation challenges and costs. Finally, we discuss the use of MgO in combination with calcite and address the technical advantages and limitations compared to other available methods.