Microbial fuel cells (MFCs) face significant challenges related to low power output, which severely limits their practical applications. Coupling MFC with other technologies and stacking MFCs are feasible solutions to enhance power output. In recent years, the coupling and stacking technology of MFCs has become a research hotspot in the field of environmental energy. This paper first outlines the basic configurations of MFCs and then analyzes the advantages and disadvantages of different setups in the context of coupling and stacking. Subsequently, it discusses in detail the coupling systems of MFC with other technologies, as well as several configurations of stacked MFCs and the phenomenon of voltage reversal. Based on these investigations, the paper proposes future research directions aimed at optimizing MFC performance, thereby enhancing their potential for energy recovery from wastewater and supporting the commercialization and scaling of MFC technology.