Algae-based wastewater treatment technologies are promising green technologies with huge economical potential and environmental co-benefits. However, despite the immense research, work, and achievement, no publications were found wherein these technologies have been successfully applied in an operational environment for nitrogen and phosphorus removal of secondary treated effluent in municipal wastewater treatment plants. Based on a literature review and targeted comprehensive analysis, the paper seeks to identify the main reasons for this. The reliability (considering inlet wastewater quality variations, operating conditions and process control, algae harvesting method, and produced biomass) as well as the technology readiness level for five types of reactors are discussed. The review shows that the reactors with a higher level of control over the technological parameters are more reliable but algal post-treatment harvesting and additional costs are barriers for their deployment. The least reliable systems continue to be attractive for research due to the non-complex operation and relieved expenditure costs. The rotating biofilm systems are currently undertaking serious development due to their promising features. Among the remaining research gaps and challenges for all the reactor types are the identification of the optimal algal strains, establishment of technological parameters, overcoming seasonal variations in the effluent’s quality, and biomass harvesting.