As a review, this paper outlines the development of the Macau gaming industry and its positive and negative impacts on society over the past15 years. A few key issues the gaming industry is facing are also covered. It argues that the gaming industry will still be the leading industry and the economic lifeline of Macau in the foreseeable future. A healthy and sustainable gaming industry is the cornerstone of Macau’s prosperity and stability. While the gaming industry has an inherent negative impact on society, the realistic options for Macau are as follows, a) to proactively minimize the negative impacts of the gaming industry, to fight against gaming-related crime and to improve responsible gambling policies, and to help the local residents in their career development so they can benefit more from the prosperity of the gaming industry; b) to actively manage the huge government surpluses, to pursue the proper economic diversification following the market principle in response to the inherent risk of a single industry being dominant, and to support the development of tourism and leisure related industries with market potential, which help Macau to become a world tourism and leisure center.