Human exposure to arsenic (As) through the consumption of rice (Oryza sativa L.) is a worldwide health concern. In this paper, we evaluated the major causes for high inorganic As levels in cooked rice foods, and the potential of post-harvesting and cooking options for decreasing inorganic As content in cooked rice, focusing particularly on As endemic areas. The key factors for high As concentration in cooked rice in As endemic areas are: (1) rice cultivation on As-contaminated paddy soils; (2) use of raw rice grains which exceed 200 μg kg-1 of inorganic As to cook rice; and (3) use of As-contaminated water for cooking rice. In vitro and in vivo methods can provide useful information regarding the bioaccessibility of As in the gastrointestinal tract. Urinary levels of As can also be used as a valid measure of As exposure in humans. Polishing of raw rice grains has been found to be a method to decrease total As content in cooked rice. Sequential washing of raw rice grains and use of an excess volume of water for cooking also decrease As content in cooked rice. The major concern with those methods (i.e. polishing of raw rice, sequential washing of raw rice, and use of excess volume of water for cooking rice) is the decreased nutrient content in the cooked rice. Cooking rice in percolating water has recently gained significant attention as a way to decrease As content in cooked rice. Introducing and promoting rainwater harvesting systems in As endemic areas may be a sustainable way of reducing the use of As-contaminated water for cooking purposes. In conclusion, post-harvesting methods and changes in cooking practices could reduce As content in cooked rice to a greater extent. Research gaps and directions for future studies in relation to different post-harvesting and cooking practices, and rainwater harvesting systems are also discussed in this review.