Municipal solid waste management (MSWM) in China warrants particular attention as China has become the largest MSW generator in the world and the total amount of MSW it produces continues to increase. In recent years, central and local governments have made great efforts to improve MSWM in China. New regulations and policies have been issued, urban infrastructure has been improved, and commercialization and international cooperation have been encouraged. Considering these developments, an overview is necessary to analyze the current state as well as new opportunities and challenges regarding MSWM in China. This paper shows that since the late 1990s, the amount of MSW collected has been largely decoupled from economic growth and incineration has become an increasingly widespread treatment method for MSW. We identify and discuss four major challenges and barriers related to China’s MSWM, and propose an integrated management framework to improve the overall eco-efficiency of MSWM.