<p>Scholars have documented historical contexts and contemporary practice of school counseling in China, highlighting the increase of school-based mental health services in schools and government support. We identified some sporadic empirical evidence concerning school counseling interventions in Chinese schools within various geographic regions. There is a lack of comprehensive and critical review of school counseling development and practice in China. In response to the gap, we performed a systematic review of articles on school counseling in China published between 2004 and 2023. Our review generated five categories: (1) Development of the Profession; (2) Social–Cultural Contexts; (3) School Counselor Roles and Activities, Counseling Interventions, and Outcomes; (4) Theoretical Models; and (5) China–West Comparison. Our findings further illuminated sociopolitical and sociocultural contexts intertwined with the development and practice of school counseling in China. We also noted stark contrasts within school counseling practice across school settings and geographic regions of China. We advocate for legitimacy and unification of school counselors’ professional identity and allocation of resources for school counseling practice in rural China.</p>