Abstract: The mining industry produces billions of tons of mine tailings annually. However, because of their lack of economic value, most of the tailings are discarded near the mining sites, typically under water. The primary environmental concerns of mine tailings are related to their heavy metal and sulfidic mineral content. Oxidation of sulfidic minerals can produce acid mine drainage that leaches heavy metals into the surrounding water. The management of tailing dams requires expensive construction and careful control, and there is the need for stable, sustainable, and economically viable management technologies. Alkali activation as a solidification/stabilization technology offers an attractive way to deal with mine tailings. Alkali activated materials are hardened, concrete-like structures that can be formed from raw materials that are rich in aluminum and silicon, which fortunately, are the main elements in mining residues. Furthermore, alkali activation can immobilize harmful heavy metals within the structure. This review describes the research on alkali activated mine tailings. The reactivity and chemistry of different minerals are discussed. Since many mine tailings are poorly reactive under alkaline conditions, different pretreatment methods and their effects on the mineralogy are reviewed. Possible applications for these materials are also discussed.