Most policy makers readily acknowledge the economic, environmental, and social benefits of moving freight and passengers by waterways. However, why do many countries struggle to develop and revive their inland waterways transportation (IWT)? One reason is because of the dearth of successful examples of IWT revival. Aside from the United States and Europe, which have been relatively successful, the experience of many emerging countries has been a tale of intensive use followed by total collapse of the IWT sector. However, the combination of societal, economic, and environmental imperatives is motivating reassessment, as countries look to develop sustainable transport systems and to curb greenhouse gas emissions from the transport sector. China’s experience has similarities to the experience of many countries and offers valuable lessons. This report is the result of an in-depth retrospective study of IWT in China and fills a gap in global knowledge. From an IWT system that carried less than 150 million tons in 1978, IWT in China carried 3.74 billion tons of cargo in 2018—six times more than either the European Union or the United States. China now has the busiest IWT system in the world. China’s leadership in IWT development started with years of investment in infrastructure that transformed low grade waterways, allowing larger vessels to use the waterways, which resulted in higher transport efficiency and lower cost. China also invested in development of skills and technical know-how. To date there are 127,000 km of inland waterways in China that have high-quality navigability and a good safety record. During the period of rapid economic development, China also adopted or developed internationally recognized technical innovations for river classification, vessel replacement, navigation technology, and environmental protection. What China achieved is informative. In particular, how and why China improved IWT provides valuable lessons for other countries.