Pitch-based carbon materials (PBCMs) are regarded as one of the most promising anodes used for alkali metal-ion (Li/Na/K) batteries due to the advantages of their low cost, high carbon yield, abundant resource, and environmental friendliness. However, PBCMs tend to be soft carbon with small layer spacing at high temperatures, resulting in undesirable reversible capacity and poor cycling stability during repeated charging and discharging, which limit their future development and application in energy storage systems. Up to now, many efforts are focused on the modification of the PBCMs to achieve excellent alkali metal-ion storage performance. In this review, the operation mechanisms and corresponding microstructural characteristics of PBCMs used for alkali metal-ion batteries are discussed. Moreover, the design and optimization strategies of PBCMs are summarized and discussed in detail, including structural adjustment strategy, heteroatom doping strategy, compound modification strategy, pre-oxidation strategy, and coating strategy, respectively. Furthermore, the research status and development prospects of PBCMs are presented, as well as a perspective on future research directions.