Optical molecular imaging has been rapidly developed to noninvasively visualize in vivo physiological and pathological processes involved in normal and suffering organisms at the cellular and molecular levels, in which advanced optical imaging technology and modern molecular biology are being combined to provide a state-of-the-art tool for preclinical biomedical research. Among optical molecular imaging modalities, bioluminescence tomography (BLT) has experienced considerable growth and attracted much attention in recent years for its excellent performance, unique advantages, and high cost-effectiveness. This article focuses on the genesis and development of BLT, especially for its computational methodology, imaging system, and biomedical application. An overview of the advantages and challenges of the conventional planar bioluminescence imaging technique is first described in comparison with currently available molecular imaging modalities. The imaging algorithms for inverse source reconstruction are classified and summarized according to different a priori knowledge, followed by a simple depiction of the uniqueness theorems of BLT solution. Diverse imaging systems for obtaining three-dimensional quantitative information of internal bioluminescent sources are then reviewed. The latest application examples of BLT in tumor study and drug discovery are introduced and compared with other mature imaging technologies. Finally, the paper is concluded and an attractive prospect for BLT is predicted.