Although nitrogen (N) is the most limiting nutrient for agricultural production, its overuse is associated with environmental pollution, increased concentration of greenhouse gases, and several human and animal health implications. These implications are greatly affected by biochemical transformations and losses of N such as volatilization, leaching, runoff, and denitrification. Half of the globally produced N fertilizers are used to grow three major cereals—rice, wheat, and maize—and their current level of N recovery is approximately 30–50%. The continuously increasing application of N fertilizers, despite lower recovery of cereals, can further intensify the environmental and health implications of leftover N. To address these implications, the improvement in N use efficiency (NUE) by adopting efficient agronomic practices and modern breeding and biotechnological tools for developing N efficient cultivars requires immediate attention. Conventional and marker-assisted selection methods can be used to map quantitative trait loci, and their introgression in elite germplasm leads to the creation of cultivars with better NUE. Moreover, gene-editing technology gives the opportunity to develop high-yielding cultivars with improved N utilization capacity. The most reliable and cheap methods include agronomic practices such as site-specific N management, enhanced use efficiency fertilizers, resource conservation practices, precision farming, and nano-fertilizers that can help farmers to reduce the environmental losses of N from the soil–plant system, thus improving NUE. Our review illuminates insights into recent advances in local and scientific soil and crop management technologies, along with conventional and modern breeding technologies on how to increase NUE that can help reduce linked N pollution and health implications.