Alkali-activation (or geopolymer) technology has gained a great deal of interest for its potential applications in water and wastewater treatment during the last decade. Alkali-activated materials can be prepared via a relatively simple and low-energy process, most commonly by treating aluminosilicate precursors with concentrated alkali hydroxide and/or silicate solutions at (near) ambient conditions. The resulting materials are, in general, amorphous, have good physical and chemical stability, ion-exchange properties, and a porous structure. Several of the precursors are industrial by-products or other readily available low-cost materials, which further enhances the environmental and economic feasibility. The application areas of alkali-activated materials in water and wastewater treatment are adsorbents/ion-exchangers, photocatalysts, high-pressure membranes, filter media, anti-microbial materials, pH buffers, carrier media in bioreactors, and solidification/stabilization of water treatment residues. The purpose of this review is to present a comprehensive evaluation of the rapidly growing prospects of alkali-activation technology in water and wastewater treatment.