Alkaline water electrolysis for hydrogen production is a promising approach to address the severe energy crisis. Membrane electrode assemblies (MEAs) provide an important place for the electrochemical reaction and multiphase transfer, which directly determines the performance and durability of alkaline water electrolysis. Thus, developing high-performance and low-cost MEAs is the key to promote the large-scale applications of alkaline water electrolysis. Herein, based on the discussion of the fundamentals of alkaline water electrolysis, we review the state-of-the-art MEAs, including electrocatalysts, ion conductive membranes, and gas/liquid diffusion layers, as well as the progress in preparation technologies of MEAs. Especially, the overall design strategies of MEAs are discussed to promote high-performance alkaline water electrolysis, thus highlighting the complex relationship of the electrocatalyst and main components with the performance of alkaline water electrolysis. Finally, the current challenges and future perspectives on the development of MEAs are discussed. This review can provide a timely reference for future directions in MEAs’ challenges and perspectives for alkaline water electrolysis.