This article discusses approaches to simultaneously increase grain yield and resource use efficiency in rice. Breeding nitrogen efficient cultivars without sacrificing rice yield potential, improving grain fill in later-flowering inferior spikelets and enhancing harvest index are three important approaches to achieving the dual goal of high grain yield and high resource use efficiency. Deeper root distribution and higher leaf photosynthetic N use efficiency at lower N rates could be used as selection criteria to develop N-efficient cultivars. Enhancing sink activity through increasing sugar-spikelet ratio at the heading time and enhancing the conversion efficiency from sucrose to starch though increasing the ratio of abscisic acid to ethylene in grains during grain fill could effectively improve grain fill in inferior spikelets. Several practices, such as post-anthesis controlled soil drying, an alternate wetting and moderate soil drying regime during the whole growing season, and non-flooded straw mulching cultivation, could substantially increase grain yield and water use efficiency, mainly via enhanced remobilization of stored carbon from vegetative tissues to grains and improved harvest index. Further research is needed to understand synergistic interaction between water and N on crop and soil and the mechanism underlying high resource use efficiency in high-yielding rice.