Macadamia (Macadamia spp.) has been widely planted in southern China and has been now developed into an important industry. China has the largest area of macadamia plantation in the world but provides only 3% production of the world. Current farming systems have a fertilizer surplus of about 73 g of nitrogen (N), 103 g of phosphorus (P), and 24 g of potassium (K) per macadamia plant per year in southern China. Optimizing fertilization recommended for macadamia improves production by about 5 kg per plant. Macadamia develops cluster roots (i.e., proteoid roots) in a P-starvation environment. Overuse of P fertilizers restrains the development of cluster roots as well as rhizosphere processes, thus decreasing the P-use efficiency. Excessive fertilization, especially P fertilization, is one of the major limiting factors in China macadamia production. This study is the first to analyze current management practices and then discuss approaches of improving nutrient management based on the specific root biology of macadamia. For a sustainable macadamia industry, it is imperative to develop appropriate nutrient management by integrating root-zone soil nutrient supply, fertilizer application, and rhizosphere processes.