The human-environment relationship within the Yellow River basin has a long history, because favorable environmental circumstances allowed the early emergence of societies along the river banks, and hence, the Yellow River basin was the birthplace of ancient Chinese civilization. On the other hand, the Yellow River is ''China's sorrow'' due to the constant occurrences of flooding events throughout history. In recent decades, the Yellow River basin is facing a spectacular economic boom, but mainly achieved at the expenses of the environment by over-exploiting the natural resources provided within the basin, which causes various challenges on ecology and society. Water scarcity, pollution, and ecosystem degradation accompanied with biodiversity decline have been further aggravated by anthropogenic-induced climate change. To address the pressing socio-ecological challenges, various conservation and management plans and strategies have been issued, often consulted by international bodies. This article is a comprehensive overview of the current state and recent developments that have occurred in the Yellow River basin and presents and discusses current and pressing socio-ecological challenges. Additionally, we address different policy and management instruments that have been launched to ensure a long-term sustainable development within the basin.