Aiming at the problems of low machining accuracy and more serious tool wear in the traditional diamond grinding machining (DGM) microstructure of hard and brittle materials, this paper proposes high-speed rotary ultrasonic machining (HRUM) technology and develops a HRUM machine tool. The hardware part of the machine tool mainly includes the spindle module, micro-motion system module, ultrasonic machining tank module, and data acquisition (DAQ) system module. The LabView-based controlled machining control system, including motion selection, initialization, coarse tool setting, constant force tool setting, control machining, and coordinate display module, is developed. Comparative experimental research of the HRUM and DGM of small holes in Al2O3 ceramics is carried out in the developed HRUM machine tool. The results demonstrate that HRUM effectively reduces axial cutting forces, reduces binder adhesion, and suppresses slippage while improving tool-cutting ability and extending tool life compared to DGM under the same machining parameters. This technology has essential research significance for the high-precision and efficient machining of microstructures in hard and brittle materials.