Sewage treatment and the removal of nutrients and metals from sewage are increasingly in demand as part of sustainable resource management. Innovative technologies are being developed to extract nutrients such as potassium, nitrogen, phosphorus, and metals like zinc, iron, and copper from sewage. These processes help mitigate environmental pollution and create opportunities for using the recovered materials in agriculture and industry. This chapter aims to compile information on the processes involved in recovering nutrients and metals from sewage, as well as to explore the superiority and drawback of these procedure. Additionally, the chapter will discuss the future needs for further development in sewage treatment processes.