Coastal areas of South China face great challenges due to heavy metal contamination caused by rapid urbanization and industrialization. In this paper, more than 90 articles on levels, distributions, and sources of heavy metals in sediments and organisms were collected to review the status of heavy metal pollution along coastal regions of South China. The results show that heavy metal levels were closely associated with local economic development. Hong Kong and the Pearl River Estuary were severely contaminated by heavy metals. However, concentrations of heavy metals in sediments from Hong Kong have continually decreased since the early 1990 s. High levels of heavy metals were found in biota from Lingdingyang in Guangdong province. Mollusks had higher concentrations of heavy metals than other species. Human health risk assessments suggested that levels of heavy metals in some seafood from coastal areas of South China exceeded the safety limit.