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Groundwater is playing an essential role in expanding irrigated agriculture in many parts of the world. Pakistan is the third-largest user of groundwater for irrigation in the world. The surface water supplies are sufficient to irrigate 27% of the area, whereas the remaining 73% is directly or indirectly irrigated using groundwater. The Punjab province uses more than 90% of the total groundwater abstraction. Currently, 1.2 million private tubewells are working in the country, out of which 85% are in Punjab, 6.4% are in Sindh, 3.8% are in Khyber-Pakhtunkhwa, and 4.8% are in Baluchistan. The total groundwater extraction in Pakistan is about 60 billion m3. The access to groundwater has helped farmers in securing food for the increasing population. However, unchecked groundwater exploitation has created severe environmental problems. These include rapidly falling groundwater levels in the irrigated areas and increased soil salinization problems. The groundwater levels in more than 50% of the irrigated areas of Punjab have dropped below 6 m, resulting in increased pumping cost and degraded groundwater quality. Despite hectic efforts, about 21% of the irrigated area is affected by different levels of salinity. The country has introduced numerous laws and regulations for the sustainable use and management of groundwater resources, but the success has so far been limited. Besides less respect for the law, unavailability of needed data and information, lack of political will and institutional arrangements are the primary reasons for poor groundwater management. Pakistan needs to revisit its strategies to make them adaptable to local conditions. An integrated water resource management approach that brings together relevant government departments, political leadership, knowledge institutions, and other stakeholders could be an attractive option.