Numerous reactor designs for biological sulfate reduction have been reported. Fluidized-bed bioreactors (FBR) can efficiently retain biomass and allow high mass transfer and reaction rates. This work reviews the development of various sulfate-reducing FBR processes for treating acidic metal- and sulfate-containing waters and recovering metals from bioleaching liquors. The FBR process performance was evaluated with continuous flow experiments under various operational conditions: fluidization rates, influent pH values, metal, sulfate and salt concentrations, hydraulic retention times, electron and carbon sources, and temperatures. Substrate utilization and sulfide inhibition kinetics were determined with batch FBR-kinetic experiments. An artificial neural network (ANN) model was used to predict the performance of the FBR. Sulfate-reducing bacteria (SRB) were characterized in FBRs with molecular and culture-based approaches with the aim to gain a better understating of the bioprocesses. Based on the studies, FBRs are well suited for the combined removal of metals, acidity and sulfate from water.