Industrial development has led to generation of large volumes of wastewater containing heavy metals, which need to be removed before the wastewater is released into the environment. Chemical and electrochemical methods are traditionally applied to treat this type of wastewater. These conventional methods have several shortcomings, such as secondary pollution and cost. Bioprocesses are gradually gaining popularity because of their high selectivities, low costs, and reduced environmental pollution. Removal of heavy metals by sulfate-reducing bacteria (SRB) is an economical and effective alternative to conventional methods. The limitations of and advances in SRB activity have not been comprehensively reviewed. In this paper, recent advances from laboratory studies in heavy metal removal by SRB were reported. Firstly, the mechanism of heavy metal removal by SRB is introduced. Then, the factors affecting microbial activity and metal removal efficiency are elucidated and discussed in detail. In addition, recent advances in selection of an electron donor, enhancement of SRB activity, and improvement of SRB tolerance to heavy metals are reviewed. Furthermore, key points for future studies of the SRB process are proposed.