Heavy metal contamination of agricultural soils poses a great threat to food safety and human health. Heavy metals enter the human body mainly through exposure pathways such as direct ingestion of soil, inhalation of soil particles, dermal exposure and food chain ingestion, with direct ingestion of heavy metal-contaminated soil and eating agricultural products being the main exposure route. Human health risk assessment plays an important role in the classification of agricultural soil quality categories and environmental risk management. Therefore, this paper reviews the development of human health risk assessment of heavy metal contamination in agricultural soils in China, introduces the basic process and assessment techniques of human health risk assessment, and discusses the main factors affecting the accuracy of human health risk assessment and the optimization measures. The research indicates that in the health risk assessment of heavy metals in farmland soil, the coupled pollution source identification technology should be strengthened while the exposure route of food consumption needs more attention. Also, the exposure parameters of different sensitive receptors should be accurately identified, and the exposure parameters of localized sensitive receptors, and the bioavailability of heavy metals should be included to improve the accuracy of health risk assessment of heavy metals in farmland soil. In the future, the health risk assessment of heavy metals in farmland soil can be deepened from many aspects, such as strengthening technical methods to deal with the uncertainty of the health risk assessment process and considering the exposure pathways of various diets. This will help with establishing localized heavy metal toxicity standard data to promote the development of the theory and technology of human health risk assessment of heavy metals in agricultural soils of China.