Rivers are basic natural resources supporting ecosystems and human societies, and the health of rivers is crucial to the Earth's sustainable development. Under the profound influence of climate change and human activities, great changes have recently occurred in the circulation and development of rivers, as well as the ways in which they are utilized. In this context, achieving an effective balance between river protection and human development is necessary. In this paper, the essential role of rivers is discussed from three aspects: the formation and evolution of rivers, the shaping of biodiversity, and the cultivation of human civilization. The paper analyzes the challenges brought to the sustainable development of rivers by climate change, human activities, and increased water demand, and proposes four dimensions of future research: scientifically balancing the relationship between river development and protection, improving the adaptability of river development and utilization in the context of climate change, improving the integrity and intelligence level of river management, and building a more fair and sustainable comprehensive river management model.