Groundwater and rural livelihoods are intricately linked in many parts of south Asia and China where millions of farmers depend on this resource for irrigated farming. This chapter summarizes and synthesizes the results of field-based investigations related to groundwater conditions, development, use, and present constraints for small scale farmers in rural parts of the Indo-Gangetic (IGB) and Yellow River basins (YRB) and in the North China Plains (NCP). Evidence from primary surveys and supplementary studies shows that intensive use of groundwater takes place under various constraints such as threats of resource depletion and lack of energy supply and other necessary agriculture-facilitating measures. Such constraints afflict mostly the poorest farmers, and potentially jeopardize food security in a wider and longer-term perspective. Influencing and optimizing these groundwater-based economies has proven to be extremely difficult and this paper tries, through a comprehensive, integrated and multidisciplinary approach, to point to various means and focus areas for research and policy that may contribute to the maintenance and enhancement of accrued benefits from groundwater irrigation in these regions.