Selenium, as an essential trace element, is intricately linked to the onset and progression of numerous diseases due to deficiencies in selenium intake. Selenium compounds exhibit tumor specificity and can efficiently inhibit the growth of tumor cells, making them potential candidates for cancer treatment. Nevertheless, given its status as one of the most widely consumed crops globally, increasing the selenium content in rice could prove advantageous in alleviating the prevailing issue of selenium intake deficiency, particularly in China. This review explored the regulatory role of selenium in rice growth, the regional distribution characteristics of soil selenium content in various rice-growing regions in China, and the impact of cultivation practices on selenium fortification in rice, aiming to suggest improved rice cultivation management strategies to enhance the capacity for rice selenium biofortification. The findings revealed that: (1) In Northeast and North China, characterized by alkaline soils and severe selenium deficiency, it is advisable to moderately decrease the duration of flooding, elevate the soil redox potential, and apply organic and nitrogen fertilizers in a judicious manner. (2) In Southwest China, which is characterized by acidic soils, alternating wet and dry irrigation should be employed, and the biofortification of selenium can be facilitated by applying lime and foliar spraying of selenium fertilizer. (3) In the south-central region of China, distinguished by acidic soils and double-cropped rice, it is recommended that intermittent or alternating wet and dry irrigation be employed, and the reasonable application of organic, silica, and selenium fertilizers is advocated. (4) In the northwest region, characterized by slightly alkaline soil and mild selenium deficiency, it is recommended to implement various water management practices, including shallow water during the seedling stage, deep water during the booting stage, and wet grain filling. Additionally, a rational application of nitrogen, phosphorus, and potassium fertilizers, along with foliar application of selenium fertilizer, should be employed. (5) Cultivating selenium-enriched, high-yielding, and high-quality rice varieties proves to be an effective strategy in addressing selenium deficiency. In conclusion, the unique characteristics of diverse rice-growing regions in China indicate that suitable water management, fertilization techniques, and varietal selection practices can effectively enhance the selenium content in rice, thereby maximizing the nutritional requirements for selenium.