The Congo Basin is more highly urbanized than most of the African continent. Gabon, Cameroon, Equatorial Guinea, and Congo have been majority urban populations for decades, and DRC will pass beyond 50% by 2030. CAR will also reach that mark within 20 years. The rapid growth of urban populations in the Congo Basin nations is discussed and key challenges for city-dwellers are assessed. Unplanned, rapid urbanization and the development of extensive slums with few services and weak political voice is the norm in the larger cities, increasing social inequity and causing crippling damage to human well-being and environmental health in peri-urban haloes, sometimes extending hundreds of kilometers from the urban center. Solutions to this growing challenge are evaluated and recommendations are made which, if implemented, could help to improve health, resilience, quality of life, and security in urban settings, as well as improving biodiversity outcomes. In the light of the sparse literature on the subject, the authors call for an urgent increase in scientific research on this pressing topic within the Congo Basin, which is a clear priority for the region’s majority urban population of the future.