Fertilizer use and genetic improvement of cereal crops contributed to increased yields and greater food security in the last six decades. For rice, however, fertilizer use has outpaced improvement in yield. Excess application of nutrients beyond crop needs, especially nitrogen (N), is associated with losses to the environment. Environmental pollution can be mitigated by addressing fertilizer overuse, improving N use efficiency, while maintaining or improving rice productivity and farmers' income. A promising approach is the site-specific nutrient management (SSNM), developed in the 1990s to optimize supply to meet demand of nutrients, initially for rice, but now extended to other crops. The SSNM approach has been further refined with the development of digital decision support tools such as Rice Crop Manager, Nutrient Expert, and RiceAdvice. This enables more farmers to benefit from SSNM recommendations. In this mini-review, we show how SSNM can foster sustainability in rice production systems through improved rice yields, profit, and N use efficiency while reducing N losses. Farmer adoption of SSNM, however, remains low. National policies and incentives, financial investments, and strengthened extension systems are needed to enhance scaling of SSNM-based decision support tools.