Diffuse pollution from agricultural runoff, characterized by intermittent discharges of complex contaminant mixtures—including nutrients, pesticides, and heavy metals (HMs)—poses a persistent threat to global water quality. Conventional "end-of-pipe" strategies often fail to address these decentralized, nonpoint sources. This review examines the evolution of Permeable Reactive Barriers (PRBs) from static, abiotic filters into modern Permeable Reactive Bio-Barriers (PRBBs), engineered as dynamic, fixed-bed biofilm reactors. A key advancement in PRBB efficacy is the exploitation of biofilm plasticity, particularly in response to coexistence with organic and inorganic pollutants. While heavy metals are traditionally viewed as inhibitors, this review synthesizes evidence showing that sub-inhibitory HM levels can act as structural and functional drivers. These metals induce the upregulation of Extracellular Polymeric Substances (EPS), creating a "protective shield" that sequesters metals and confers functional resilience on the microbial consortia responsible for nutrient removal and pesticide biodegradation. The review analyzes contaminant removal mechanisms, highlighting the bio-chemo synergy between reactive media and biofilms, and proposes a classification framework based on target contaminants, media, and technological integration. Significant focus is placed on emerging hybrid multi-media systems designed to protect the "biological engine" from toxic metal shocks, alongside the integration of artificial intelligence for predictive control. While challenges in hydraulic sustainability and field validation remain, PRBBs represent a compact, low-energy, and scalable eco-technology. They offer a strategically targeted solution within the Nature-Based Solutions toolkit for building resilient protection of aquatic ecosystems at the critical land-water interface.