The great practice of China’s targeted poverty alleviation and reduction strategy has promoted the continuous improvement of regional poverty governance ideas. On the basis of summarizing the dialectical relationship between individual poverty alleviation and regional poverty alleviation, poverty-stricken areas and regional poverty governance needs, and based on the specific Chinese practice of targeted poverty alleviation, this article systematically reviewed the ideas of regional governance of poverty-stricken areas, aiming to enrich the theoretical system of targeted poverty alleviation, and provide a reference for the implementation of China’s rural revitalization strategy and the international action of the global poverty reduction by in 2030. The main conclusions are as follows: (1) The idea of regional poverty governance includes three aspects: poverty spatial differentiation, poverty region development strategy, and poverty region management, corresponding to the precision identification, precision assistance, and precision management of the targeted poverty alleviation strategy, which provides the theoretical basis and practical tools for targeted poverty alleviation; (2) The poverty-stricken areas show significant spatial differences and spatial differentiation characteristics. They are divided into poverty-stricken county and village categories, and the areas that are difficult to get rid of poverty and where poor counties are concentrated are divided into concentrated and contiguous special poverty areas; (3) Based on the regional development theories of resources science, geography, and other disciplines, a poverty region development strategy is formed, which is composed of eastern-western region cooperation and counterpart support, priority development of agriculture and rural areas, and differentiated measures according to local conditions; (4) Based on the distinct hierarchical system of poverty-stricken areas, a poverty alleviation object system of “poverty county, poverty village, poverty household” is formed and the exit assessment mechanism is proposed, and the poverty region management means composed of the working mechanism of “central government responsible for overall planning, provincial government taking overall responsibility, city and county governments responsible for implementation” are suggested.