In recent years, reducing the concentration of carbon dioxide in the atmosphere has become an important issue. Microalgae have a higher photosynthetic efficiency and growth rate than higher plants; thus, biological carbon dioxide fixation using microalgae is attracting particular attention as an efficient carbon dioxide fixation method. However, under dilute atmospheric conditions, microalgae exhibit lower growth rates and reduced carbon dioxide fixation efficiency. In recent years, technology that can efficiently fix carbon dioxide, even in the atmosphere, using a microalgae co-culture system that co-cultivates microalgae and heterotrophic microorganisms has attracted attention. In such a co-culture system, it is believed that a mutualistic relationship is established between microorganisms through the exchange of various compounds. This review focuses on the application of a co-culture system of microalgae and heterotrophic microorganisms for bioproduction and wastewater treatment. In addition, research to elucidate the mutualistic relationships in microalgal co-culture systems using analytical methods that have been widely used in recent years, such as next-generation sequencing technology, is also discussed. In the future, it is expected that the use of microalgae co-culture systems will expand on an industrial scale through the development of key technologies, such as efficient genetic modification techniques for microalgae and their heterotrophic microorganism partners, large-scale cultivation facilities that can efficiently cultivate microalgae, and stable control techniques for co-culture systems using advanced technology.