Rice in Thailand, Laos and Cambodia (the Mekong region) is grown mostly as a mono crop once a year in the wet season in the rainfed lowlands. Some lowland areas have access to irrigation water, and rice double cropping is practised while non-rice crops are grown in a limited area in the dry season after harvesting wet season rice. In all cases wet season rice is grown mostly for subsistence under rainfed with low input, and combined with low soil fertility and frequent occurrence of drought, the yield is generally low with a mean of 2.5 t/ha and the yield increase was slow in recent years. More recently demand for labour in the regional centres has caused labour shortages in the rural area and rice crops may not be managed in the traditional manner such as the practice of manually transplanting of rice seedlings. For the last two decades research efforts have been made to minimise the adverse effect of abiotic factors and to meet the changing nature of the socioeconomic environment, resulting in increased understanding of factors determining productivity of rainfed lowland rice and the cropping systems based on it. This review describes such achievements in five sections – water environment characterisation to quantify drought problems, soil environment and fertiliser management, direct seeding to develop technology to cope with the labour shortage, variety improvement for rainfed lowland rice in drought-prone environment, and crop intensification and diversification that shift practices from traditional subsistence agriculture to more market-oriented agriculture. Each section is concluded with issues for future research need. The last section of the paper describes future research challenges for the rainfed rice-based lowland cropping systems in the Mekong region and possible implication on rainfed lowland rice system on other regions.