The unavoidable increase in train speed and load, as well as the aging of railway facilities, is requiring more and more attention to rail defects detection. As a promising tool for rail, in-service high-speed inspection, guided wave–based detection technologies have been developed in succession by researches in the past two decades. However, there is a lack of a systematic review on the developments and performances of these technologies. This article reviews ultrasonic rail inspection methods comprehensively with the focus on the state-of-the-art technologies based on guided wave. Different excitation options, including train wheel, electromagnetic acoustic transducer, pulsed laser, air-coupled, and contact piezoelectric transducer, are described, respectively, along with their inspection sensitivities, regions, and potential speeds. Finally, future challenges and prospects are discussed to a certain extent to provide references for researchers in this area.