Hydrothermal ore deposits represent a convergence of fluid flow, thermal energy, and solute flux that is hydrogeologically unusual. From the hydrogeologic perspective, hydrothermal ore deposition represents a complex coupled-flow problem—sufficiently complex that physically rigorous description of the coupled thermal (T), hydraulic (H), mechanical (M), and chemical (C) processes (THMC modeling) continues to challenge our computational ability. Though research into these coupled behaviors has found only a limited subset to be quantitatively tractable, it has yielded valuable insights into the workings of hydrothermal systems in a wide range of geologic environments including sedimentary, metamorphic, and magmatic. Examples of these insights include the quantification of likely driving mechanisms, rates and paths of fluid flow, ore-mineral precipitation mechanisms, longevity of hydrothermal systems, mechanisms by which hydrothermal fluids acquire their temperature and composition, and the controlling influence of permeability and other rock properties on hydrothermal fluid behavior. In this communication we review some of the fundamental theory needed to characterize the physical hydrogeology of hydrothermal systems and discuss how this theory has been applied in studies of Mississippi Valley-type, tabular uranium, porphyry, epithermal, and mid-ocean ridge ore-forming systems. A key limitation in the computational state-of-the-art is the inability to describe fluid flow and transport fully in the many ore systems that show evidence of repeated shear or tensional failure with associated dynamic variations in permeability. However, we discuss global-scale compilations that suggest some numerical constraints on both mean and dynamically enhanced crustal permeability. Principles of physical hydrogeology can be powerful tools for investigating hydrothermal ore formation and are becoming increasingly accessible with ongoing advances in modeling software.