Per- and polyfluoroalkyl substances (PFAS) have drawn great attention due to their wide distribution in water bodies and toxicity to human beings. Adsorption is considered as an efficient treatment technique for meeting the increasingly stringent environmental and health standards for PFAS. This paper systematically reviewed the current approaches of PFAS adsorption using different adsorbents from drinking water as well as synthetic and real wastewater. Adsorbents with large mesopores and high specific surface area adsorb PFAS faster, their adsorption capacities are higher, and the adsorption process are usually more effective under low pH conditions. PFAS adsorption mechanisms mainly include electrostatic attraction, hydrophobic interaction, anion exchange, and ligand exchange. Various adsorbents show promising performances but challenges such as requirements of organic solvents in regeneration, low adsorption selectivity, and complicated adsorbent preparations should be addressed before large scale implementation. Moreover, the aid of decision-making tools including response surface methodology (RSM), techno-economic assessment (TEA), life cycle assessment (LCA), and multi criteria decision analysis (MCDA) were discussed for engineering applications. The use of these tools is highly recommended prior to scale-up to determine if the specific adsorption process is economically feasible and sustainable. This critical review presented insights into the most fundamental aspects of PFAS adsorption that would be helpful to the development of effective adsorbents for the removal of PFAS in future studies and provide opportunities for large-scale engineering applications.