China is one of the major cotton producers globally with small farmers. Lepidopteran pests have always been the main factor affecting cotton production. To reduce the occurrence of and damage caused by lepidopteran pests, China has employed a pest control method focused on planting Bt (Cry1Ac) cotton since 1997. Chinese resistance management tactics for the main target pests, the cotton bollworm and pink bollworm, were also implemented. For polyphagous (multiple hosts) and migratory pests such as the cotton bollworm (Helicoverpa armigera), the “natural refuge” strategy, consisting of non-Bt crops such as corn, soybean, vegetables, peanuts, and other host crops, was adopted in the Yellow River Region (YRR) and Northwest Region (NR). For a single host and weak migration ability pest, such as the pink bollworm (Pectinophora gossypiella), the seed mix refuge strategy yields a random mixture within fields of 25% non-Bt cotton by sowing second-generation (F2) seeds. According to field monitoring results for more than 20 years in China, practical resistance (Bt cotton failure) of target pests was avoided, and there were no cases of Bt (Cry1Ac) failure of pest control in cotton production. This indicated that this Chinese resistance management strategy was very successful. The Chinese government has decided to commercialize Bt corn, which will inevitably reduce the role of natural refuges; therefore, this paper also discusses adjustments and future directions of cotton pest resistance management strategies.