The discovery of the first isolable N-heterocyclic carbene in 1991 ushered in a new era in coordination chemistry. The remarkable bonding properties of carbenes have led to their rapid proliferation as auxiliary ligands for a wide range of transition metals and main group elements. In the case of group 15, while carbene-stabilized nitrogen and phosphorus compounds are extensively studied, the scope of research has shrunk significantly from arsenic to bismuth. This is essentially attributed to the decrease in stability of the C-E bond upon descending the group. Even so, modulating the carbene backbone or introducing alternative synthetic strategies not only alleviates the stability issues but also offers promising results in terms of the bonding and reactivities of these compounds. The purpose of the present perspective is to provide a comprehensive overview of the origins and development of carbene chemistry of arsenic, antimony, and bismuth, as well as to highlight the future prospects of this field.