Cork oak (Quercus suber L.) is an emblematic component of western Mediterranean basin landscapes. Cork oak forests have always been highly appreciated by local populations for their great ecological and socio-economic value. However, the sustainability of cork oak forests has been threatened in recent decades by a complex phenomenon of degradation called “oak decline”, worsened by the increase of anthropogenic and climatic disturbances combined with a lack or scarcity of natural cork oak regeneration. All these disturbances disrupt key components of the ecosystem, notably the rhizosphere microbiome, potentially sharpening decline processes and forest ecosystem degradation in return. This review provides an overview of the main abiotic and biotic decline drivers and a comprehensive state of knowledge about the impact of decline-related cork oak forest degradation on rhizosphere microbiome in Mediterranean basin. Finally, perspectives for the improvement of cork oak forest sustainability through the development of ecological management strategies based on rhizosphere microbiome-driven plant managements are highlighted.