Over the past few decades, one of the most significant advances in dam construction has been the invention of the rock-filled concrete (RFC) dam, which is constructed by pouring high-performance self-compacting concrete (HSCC) to fill the voids in preplaced large rocks. The innovative use of large rocks in dam construction provides engineers with a material that requires less cement consumption and hydration heat while enhancing construction efficiency and environmental friendliness. However, two fundamental scientific issues related to RFC need to be addressed: namely, the pouring compactness and the effect of large rocks on the mechanical and physical properties of RFC. This article provides a timely review of fundamental research and innovations in the design, construction, and quality control of RFC dams. Prospects for next-generation concrete dams are discussed from the perspectives of environmental friendliness, intrinsic safety, and labor savings.