This review proposes an insight into the prospects of electrochemistry for the treatment of highly concentrated effluents in three sections. The first section focuses on the challenges inherent to such kind of wastewater, divided into five categories: industrial wastewater (e.g., pharmaceutical, electronics, chemical, food-processing), hypersaline effluents (e.g., RO concentrates), solutions contaminated with a mixture of organic and inorganic contaminants (e.g., leachate, mining), highly viscous solution (or non-Newtonian liquid) (e.g., sludge) and solutions of high COD load but with low pollutant content (e.g., from soil washing). The second section of this review then focuses on the treatment strategies to ensure that the electrochemical treatment is adapted to these very specific waste streams, including the influence of operating conditions, electrode materials and processes (with special emphasis on anodic oxidation, electro-Fenton and electrocoagulation). The final part focuses on the perspectives of electrochemical treatment of challenging wastewater, by giving the engineering parameters to ensure successful upscaling of electrochemical processes in terms of modeling mass transport, charge transfer and hydrodynamics, reactor designs and energy requirements. The review concludes on process combinations, where electrochemistry could complement traditional methods of treatment, in order to improve the overall efficiency of the integrated system.