Human pharmaceuticals are receiving increased attention as environmental contaminants. This is due to their biological activity and the number of monitoring programs focusing on analysis of these compounds in various environmental media and compartments. Risk assessments are needed to understand the implications of reported concentrations; a fundamental part of the risk assessment is an assessment of environmental exposures. The purpose of this chapter is to provide guidance on the use of predictive tools (e.g., models) and monitoring data in exposure assessments for pharmaceuticals in the environment. Methods to predict environmental concentrations from equations based on first principles are presented. These equations form the basis of existing GIS (geographic information systems)-based systems for understanding the spatial distribution of pharmaceuticals in the environment. The pharmaceutical assessment and transport (PhATE), georeferenced regional exposure assessment tool for European rivers (GREAT-ER), and geographical information system (GIS)-ROUT models are reviewed and recommendations are provided concerning the design and execution of monitoring studies. Model predictions and monitoring data are compared to evaluate the relative utility of each approach in environmental exposure assessments. In summary, both models and monitoring data can be used to define representative exposure concentrations of pharmaceuticals in the environment in support of environmental risk assessments.