Environmental damage caused by improper wastewater treatment is a global problem, especially in developing countries such as Indonesia. With limited land availability, cost, and human resources, one of the potential technologies that excels in terms of cost-effectiveness is biological treatment technology. Moving Bed Biofilm Reactor (MBBR) and Integrated Fixed-Film Activated Sludge (IFAS), as modifications to conventional activated sludge, utilize solid media that are either suspended or fixed in the reactor to enhance the biological growth of microorganisms to improve the treatment efficiency. Despite the common researches and practices of MBBR and IFAS for the treatment of wastewater in many countries, the implementations of these technologies in Indonesia are still minimal due to lack of understanding of the principles of these methods, particularly IFAS. The aim of this study is to present a review of MBBR and IFAS and to analyze the challenges of implementing both technologies in Indonesia for better understanding of the principles and a more balance use of these technologies according to their advantages in different cases of wastewater treatment. The application of MBBR technology using small-size suspended media distributed in the reactor is more commonly found in Indonesia due to ease of implementation, especially when it is applied as improvement to the existing wastewater treatment systems. IFAS technology using a fixed media introduced into the reactor requires more modifications and redesign compared to MBBR when applied to an existing system. Comparison of both technologies as designs for a new wastewater treatment plant showed that IFAS requires shorter hydraulic retention time and less energy to operate than MBBR. The costs for both systems are roughly the same. In conclusion, MBBR and IFAS have their own advantages that can be applied to wastewater treatment in Indonesia with MBBR suitable for improving existing activated sludge system and implementation of IFAS in new facility design to achieve a more efficient and economical operation. The review in this study can be used to broaden the perspective of wastewater treatment practitioners, facility owners and government officials in choosing and applying MBBR and IFAS technologies in specific cases of wastewater treatment.