With the global industrialization process and socioeconomic development, the amount of municipal solid waste (MSW) generated is growing significantly. With the growth trend of municipal solid waste, incineration is widely used for waste treatment but produces a large amount of municipal solid waste incineration fly ash, which contains heavy metals that can seriously harm human health and the ecological environment. In this Review, the current situation of MSWI fly ash disposal is reviewed, and the technologies for harmless disposal and resource utilization of heavy metals in MSWI fly ash are summarized, including solidification stabilization, leaching extraction, heat treatment, combination methods, etc. We meticulously summarized the recent progress of various incineration fly ash disposal technologies, analyzed the difficulties and solutions in formulating various feasible technical strategies, and compared their potential in the safe, environmentally friendly, and economical utilization of MSW fly ash resources. Furthermore, we also provide an outlook on the potential challenges and prospects of future progress in the harmless disposal and resource recycling of fly ash.