Problems treating sewage in rural areas in China have attracted increasing attention in recent years. However, only 6% of rural areas had spray drainage and wastewater treatment systems by the end of 2010. It is necessary to assess the technologies currently used so that sewage treatment in rural areas can be developed appropriately, to provide reliable and affordable wastewater treatment, in these areas. We evaluated the sewage treatment technologies currently used in rural areas by conducting case studies on 62 facilities that had each been operating for at least one year. Our study was carried out between 2009 and 2011, and the aim was to assess the situation during that period and assess any problems involved in decentralized sewage treatment in villages. We found that decentralized sewage treatment is the most popular wastewater treatment method in villages, and that the most common primary treatment technology used in rural areas is the septic tank. Our investigation highlights the need to establish standards for assessing effluent quality, including a range of target pollutants. Our results also show that effluents should be reused to meet the local environmental requirements in different areas, especially in ecologically sensitive areas.