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This review analyzes the state-of-the-art of a specific niche in biological wastewater treatment that uses immobilized eukaryotic microalgae (and several prokaryotic photosynthetic cyanobacteria), with emphasis on removing nutrients with the support of microalgae growth-promoting bacteria. Removal of other pollutants by this technology, such as heavy metals and industrial pollutants, and technical aspects related to this specific subfield of wastewater treatment are also presented. We present a general perspective of the field with most known examples from common literature, emphasizing a practical point of view in this technologically oriented topic. The potential venues of future research in this field are outlined and a critical assessment of the failures, limitations, and future of immobilized microalgae for removal of pollutants is presented.