River ecosystems face growing threats from human‐induced stressors, resulting in habitat degradation and biodiversity loss. Crucial to these ecosystems, macroinvertebrates maintain river health and functioning. In this review, we examine the challenges confronting macroinvertebrates, explore restoration strategies and management approaches, and shed light on knowledge gaps and future research directions. Habitat degradation, water pollution, climate change, and invasive species are discussed as key challenges. Various restoration strategies, such as in‐stream habitat restoration, flow regime restoration, riparian zone restoration, and connectivity restoration, are evaluated for macroinvertebrate conservation. Integrated catchment management, adaptive management, community‐based management, monitoring, and policy integration are highlighted as essential management approaches, and knowledge gaps in long‐term monitoring, innovative restoration techniques, climate change resilience, and policy incorporation are identified as areas calling for further research. Ultimately, a proactive, adaptable, and cooperative approach to river management will ensure macroinvertebrate conservation and sustainable river ecosystems.