Rural domestic sewage treatment is an important issue to be solved in the rural revitalization strategy in the coming decades in China. Based on the strategic goals for rural revitalizing and improving rural human settlement environment and on-site surveys about rural domestic sewage treatments in Henan Province, this paper examined and analyzed the treatment scheme and countermeasures of rural domestic sewage. Results showed that domestic sewage discharge in Henan Province reached about 1 billion tons in 2017, of which ammonia nitrogen emission was 59.4 million tons. Villages with sewage treatment facilities in the province were less than 5%, and the daily treatment capacity was generally less than 100 tons. There are many different types of domestic sewage treatment technique in rural areas of Henan Province. Main operations are those integrated equipment facilities with daily treatment scale of 50~200 tons. With some great achievements in the treatment of rural domestic sewage in Henan Province, some big challenges exit, including lack of top-level design, overdependence on state financial support, lack of diversified investment and market operation mechanism, ambiguity of the main body’s responsibilities, and absence of uniformed standard. Therefore, this paper suggests: 1) strengthening the top-level design to construct a long-term financial investment and management mechanism; 2) introducing market mechanism to emphasize operation maintenance and management; 3) strengthening the subject responsibility of local government to set responsibility boundary and performance appraisal system; and 4) paying attention to policy planning and design to choose processing technologies according to local conditions.