The main rice-producing areas in Southwest China are facing production problems such as seasonal drought and engineering water shortage. A green and efficient irrigation and drainage technology system is key to achieving water conservation, stable yield, and high efficiency in the region, and it is of great significance to the food security of China. This study reviews the current status of water use, irrigation, and drainage in the main rice-producing areas in Southwest China, involving Yunnan, Guizhou, Sichuan, and Chongqing. It examines the basic characteristics and specific technical types of green and efficient irrigation and drainage systems in the areas, and proposes a green and efficient irrigation and drainage technology model that is composed of accurate water demand forecast of paddy fields, precision water distribution management in irrigation areas, efficient water use management in paddy fields, and efficient drainage management in paddy fields. The study found that the main rice-producing areas in Southwest China are rich in water resources but uneven in spatial and temporal distribution of water. The water-saving irrigation and drainage technologies in this region are backward and vary in the applicability of climate conditions, water resources, and topography. Therefore, we propose the following suggestions: (1) developing new technologies for the efficient and coordinated regulation of irrigation and drainage in paddy fields, (2) promoting the green and efficient irrigation and drainage technology system, (3) optimizing the water and fertilizer operation mode, (4) developing an intelligent irrigation system for paddy fields, (5) establishing a paddy field information management system, and (6) building a multi-dimensional technology promotion system, thus to achieve water conservation, pollution control, emission reduction, yield increase, and quality improvement in the main rice-producing areas of Southwest China.