The arid and semi-arid regions of our planet support extraordinary freshwater biodiversity but its long-term sustenance requires maintaining a delicate balance between water consumption and natural replenishment. Preparing a detailed and accurate water budget that accounts for both replenishment (inputs) and all forms of consumption -- both human and environmental -- is a crucially important foundation for successful water governance. A water budget helps water managers and users to understand how and where water is being consumed, and whether a condition of overdraft or unsustainable use exists. Groundwater systems are particularly difficult to manage well, due to limited natural recharge (replenishment) and the pervasive use of aquifers as primary water supplies in dry regions. When aquifers are being overdrafted, a variety of corrective strategies must be implemented to bring the hydrologic system back into a sustainable balance. The Cuatro Cienegas aquifer system has been in an overdraft status since 2012, due to a combination of reduced replenishment driven in part by climate warming, and an expansion of water consumption for both domestic use and in irrigated agriculture to produce alfalfa, fodder corn, and fodder oats. This presentation will summarize available management solutions based on examples from dry regions around the globe.