Groundwater is an important part of the global hydrological cycle. Sustainable utilization of groundwater is related to regional ecological security and food security, especially in arid and semi-arid environments. This paper reviewed the important achievements of the research on groundwater sustainability in arid and semi-arid environments during the past 30 years, and summarized the research progress in groundwater sustainability of arid and semi-arid environments from the conception evolution of groundwater sustainability, evaluation methods, influencing factors, sustainable management, and research frontiers. Our analysis suggests that groundwater in water limited environments around the world has shown unsustainable characteristics both in terms of quantity and quality. However, the existing research focuses more on the quantitative characteristics than the quality characteristics of groundwater, and thus the seriousness of the decline in groundwater sustainability is potentially underestimated. It is pointed out that more research efforts need to be done in the future in balancing the groundwater resources for human and nature, clarifying the impacts of human disturbance and climate change on groundwater sustainability, and strengthening groundwater sustainability through transboundary watershed management. We argued that the difficulty remains how to quantify the sustainable yield of a groundwater basin, and how to assess the groundwater sustainability. Further investigations are required in improving the theoretical framework of groundwater sustainability, modeling the impacts of the various alternative groundwater development scenarios, developing more flexible and efficient indicator frameworks for sustainability evaluation of groundwater system, and deploying more sophisticated groundwater monitoring network for real-time data acquisition. Finally, awareness should also be raised towards ground water sustainability both at the legal level and in the sphere of political action.