Sugar beet root maggot is a serious insect pest of sugar beet of the upper Midwestern and Western states of the U.S. The main control of this pest is the use of chemical insecticides. Environmental safety concerns, insect resistance, and the lack of new chemistries are worrisome, as is the limited sources of sugar beet root maggot resistant germplasm. In the absence of control measures against sugar beet root maggot, a total yield reduction valued at $446 million can be observed annually in the U.S. This breeding review is to understand and highlight the bottlenecks of sugar beet root maggot resistant breeding by summarizing sugar beet biology, breeding methods and insect biology. Conventional breeding methods and a naturally infested insect nursery were used for selection of the two most promising root maggot resistant germplasm. However, conventional breeding methods have not been able to deliver diverse and highly resistant lines to date. The absence of desirable root maggot resistance traits is attributed to host and pest evolution in two different distinct geographical regions. Lack of understanding of host pest interactions has been the primary obstacle of creating an effective screening system to overcome the challenges of traditional field nurseries. In conclusion, the development of an efficient assay method could facilitate identification of resistance through genome studies or a mutation breeding approach to generate desirable resistance.