Throughout history, and throughout the world, groundwater has been a major source of water for sustaining human life. Use of this resource has increased dramatically over the last century. In many areas of the world, the balance between human and ecosystem needs is difficult to maintain. Understanding the international scale of the groundwater issue requires metrics and analysis at a commensurate scale. Advances in remote sensing supplement older traditional direct measurement methods for understanding the magnitude of depletion, and all measurements motivate the need for common data standards to collect and share information. In addition to metrics of groundwater availability, four key international groundwater issues are depletion of water, degradation of water quality, the water-energy nexus, and transboundary water conflicts. This chapter is devoted to introducing these issues, which are also discussed in more detail in later chapters.