This study assesses the status of currently available extraction technologies for lithium recovery from geothermal waters based on recent scientific studies and identifies potential technical challenges. Available technologies are evaluated in terms of their applicability and integrability in geothermal energy production. Current research projects have validated various extraction methods at laboratory and prototype scale. Scaling up to an industrial process has not yet been performed. Accordingly, information regarding continuous operation as well as site-specific challenges and actual economic viability is lacking. The amount of recoverable lithium depends primarily on the concentration of lithium dissolved in the water, the extraction efficiency and rate, and the amount of extractant used. The interaction of these factors determines the process technology and the size of the extraction infrastructure. Depending on the chosen Li extraction method, the physicochemical properties of the water (pH, Eh, T, p, etc.) are altered during extraction, which can increase scaling and corrosion potential. The current status indicates an early to medium technology readiness level while reaching lithium extraction efficiencies of 50–90% in laboratory experiments. Under the disproportionately higher challenges of ongoing operation in a geothermal plant, extraction efficiencies at the bottom of this range are considered realistic.