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Drought in Africa has been extensively researched, particularly from meteorological, agricultural, and food security perspectives. However, the impact of drought on water security, particularly ground water dependent rural water supplies, has received much less attention. Policy responses have concentrated on food needs, and it has often been difficult to mobilize resources for water interventions, despite evidence that access to safe water is a serious and interrelated concern. Studies carried out in Ghana, Malawi, South Africa, and Ethiopia highlight how rural livelihoods are affected by seasonal stress and longer-term drought. Declining access to food and water is a common and interrelated problem. Although ground water plays a vital role in buffering the effects of rainfall variability, water shortages and difficulties in accessing water that is available can affect domestic and productive water uses, with knock-on effects on food consumption and production. Total depletion of available ground water resources is rarely the main concern. A more common scenario is a spiral of water insecurity as shallow water sources fail, additional demands are put on remaining sources, and mechanical failures increase. These problems can be planned for within normal development programs. Water security mapping can help identify vulnerable areas, and changes to monitoring systems can ensure early detection of problems. Above all, increasing the coverage of ground water-based rural water supplies, and ensuring that the design and siting of water points is informed by an understanding of hydrogeological conditions and user demand, can significantly increase the resilience of rural communities to climate variability.