Ecological and socioeconomic aspects of subterranean hydrosystems have changed during the past 40–50 years. The major environmental pressures (mainly anthropogenic ones) impact the quantity and quality of groundwater resources and the state of subsurface ecosystems, and it is expected that the environmental pressures on groundwater will continue, at least until 2025, unless new environmental policies change this state of affairs. The world demographic increase and the general rise of water demand constitute one of the major environmental pressures on groundwater ecosystems especially in less developed countries in Africa, Asia and South America. Specific human activities leading to the depletion of groundwater reserves include agricultural practices, landscape alteration, urbanization demand for domestic and public drinking water, various industrial activities such as thermoelectric production and mining, and the rise of tourism in coastal areas. Climate change is contributing to the water crisis too, especially in areas with arid climate and/or in some humid monsoonal countries. The overload of aquifers with pollutants derived from agriculture (fertilizers and pesticides), from industry (release of hydrocarbon chemicals, especially spills), from waste and industrial waters, from domestic and industrial landfills, from the infiltration of pollutants from surface and from the intrusion of saline water affect groundwater quality. The dangerous increase in contaminated subsurface sites with chemicals and microbial pathogens brings with it health risks to humans. Changes of redox condition in groundwater zones, changes of biological diversity, vegetation changes with modification of agriculture practices and impacts at the biosphere scale, such as the increase in the concentration of nitrous oxides in the atmosphere, all impact groundwater ecosystems. Groundwater ecosystems must be better investigated and understood. Economic, social and ecological lines of thinking have to be combined in order to achieve meaningful policies for the sustainable development of groundwater reserves and for the protection of subsurface ecosystems. Practical measures and ideas for the development of policies up to the 2025 time-horizon should improve the sustainable usage of the world's groundwater resources.