In this review paper, the principles of MC modeling for the simulation of light transport in tissues, including the general procedure of tracking an individual photon packet, common light–tissue interactions that can be simulated such as light absorption and scattering, frequently used tissue models, common contact and noncontact illumination and detection setups, and the treatment of time-resolved and frequency-domain optical measurements, are described in detail to help interested readers achieve a quick start. Following that, a variety of methods for speeding up MC simulations, including scaling methods, perturbation methods, hybrid methods, variation reduction techniques, parallel computation, and special methods for fluorescence simulations, and their respective advantages and disadvantages are discussed. Then the biomedical applications of MC methods, including the simulation of optical spectra, estimation of optical properties, simulation of optical measurements in laser Doppler flowmetry (LDF), simulation of light dosage in photodynamic therapy (PDT), simulation of signal source in optical coherence tomography (OCT) and diffuse optical tomography (DOT), are surveyed. Finally, the potential directions for the future development of MC methods are discussed, which are based on their current status in the literature survey and the authors’ anticipation. It should be pointed out that this review is intended to give a general survey on the capability of MC modeling in tissue optics while paying special attention on methods for speeding up MC simulations since the time-consuming nature of common MC simulations could limit its applications.