Cooling towers are extensively utilized in diverse industries for efficient heat dissipation. Fill media are a critical component, facilitating heat and mass exchange between water and air, impacting overall cooling tower efficiency. Given its vital importance, this study comprehensively reviews recent advancements in fill media technology, illuminating cooling tower technology progress and exploring the effects of different fill media configurations and materials on cooling tower performance. It should be noted that the majority of research is focused on the Range of 2.5 °C to 25 °C and Approach of 1 °C to 9 °C. Through comprehensive analysis and evaluation, the effects of various fill media on heat transfer efficiency, water cooling capacity, and energy consumption are intensively summarized. By understanding these effects, engineers and designers can make rational decisions to optimize cooling tower performance and ensure efficient heat dissipation. Notably, in some reported cases, new fill media enhanced cooling range, effectiveness, and the Merkel number by 28%, 85%, and 131%, respectively. Ultimately, this paper serves as a valuable resource for academics, researchers, and professionals in the field of cooling tower design and thermal management. The insights provided in this study can help industries achieve greater energy efficiency, sustainability, and overall operational excellence.