Nephrolithiasis, commonly known as kidney stones, may be localized to any part of the urothelial system, causing common systemic symptoms, some of which may become acute. Primary care physicians increasingly are the first line of management for this condition, making recognition and prompt treatment essential. This article highlights the pathogenesis of kidney stones, the risk factors for their formation, and common complications. The article concludes with management guidelines for nephrolithiasis and when primary care physicians should refer patients to nephrology or urology. In light of the current opioid epidemic, salient points for nonopioid treatment as initial treatment of nephrolithiasis likewise are discussed.