Synthetic nitrogen (N) fertilizer has enabled modern agriculture to greatly improve human nutrition during the twentieth century, but it has also created unintended human health and environmental pollution challenges for the twenty-first century. Averaged globally, about half of the fertilizer-N applied to farms is removed with the crops, while the other half remains in the soil or is lost from farmers’ fields, resulting in water and air pollution. As human population continues to grow and food security improves in the developing world, the dual development goals of producing more nutritious food with low pollution will require both technological and socio-economic innovations in agriculture. Two case studies presented here, one in sub-Saharan Africa and the other in Midwestern United States, demonstrate how management of nutrients, water, and energy is inextricably linked in both small-scale and large-scale food production, and that science-based solutions to improve the efficiency of nutrient use can optimize food production while minimizing pollution. To achieve the needed large increases in nutrient use efficiency, however, technological developments must be accompanied by policies that recognize the complex economic and social factors affecting farmer decision-making and national policy priorities. Farmers need access to affordable nutrient supplies and support information, and the costs of improving efficiencies and avoiding pollution may need to be shared by society through innovative policies. Success will require interdisciplinary partnerships across public and private sectors, including farmers, private sector crop advisors, commodity supply chains, government agencies, university research and extension, and consumers.