Gold mine tailings in South Africa present significant environmental challenges, including pollution of land and water, loss of biodiversity, and depletion of resources. To tackle these issues, it is crucial to explore alternative management strategies that focus on reusing tailings. This comprehensive review delves into potential applications for reusing gold mine tailings (GT) in South Africa. Ex-situ reuse possibilities include brick making, ceramics, cement additives, clinker production, alkali-activated materials, and stone paper production. In-situ options span from generating clean energy to agricultural and recreational uses. However, several challenges impede widespread adoption, such as the properties of tailings (including radioactive and toxic metals), technological limitations, economic feasibility, corporate culture, and regulatory barriers. Fragmented legislation and a regulatory emphasis on waste disposal further complicate tailings reuse efforts. Overcoming these obstacles necessitates innovative solutions, interdisciplinary collaboration, and supportive policies to capitalize on the potential of GT as a valuable resource within the circular economy. Successfully addressing environmental concerns and regulatory requirements requires a deep understanding of immobilization mechanisms and lifecycle analysis.