Rice is the main staple food for a large population around the world, while it generally has a high glycemic index and low resistant starch (RS) content. Although many strategies have been applied to develop healthier rice products with increased RS contents, their actual effects on gut microbiota and human health remain elusive. In this review, currently available production methods of rice RS are briefly summarized, followed by a critical discussion on their interactions with gut microbiota and subsequent effects on human health, from correlation implications to causal mechanisms. Different contents, types, and structures of RS have been produced by strategies such as genetic manipulation and controlling cooking conditions. The difference can largely determine effects of rice RS on gut microbiota composition and metabolites by specific RS−gut microbiota interactions. This review can thus help the rice industry develop rice products with desirable RS contents and structures to generally improve human health.