In the twentieth century, groundwater characterization focused primarily on easily measured hydraulic metrics of water storage and flows. Twenty-first century concepts of groundwater availability, however, encompass other factors having societal value, such as ecological well-being. Effective ecohydrological science is a nexus of fundamental understanding derived from two scientific disciplines: (1) ecology, where scale, thresholds, feedbacks and tipping points for societal questions form the basis for the ecologic characterization, and (2) hydrology, where the characteristics, magnitude, and timing of water flows are characterized for a defined system of interest. In addition to ecohydrology itself, integrated groundwater management requires input from resource managers to understand which areas of the vast world of ecohydrology are important for decision making. Expectations of acceptable uncertainty, or even what ecohydrological outputs have utility, are often not well articulated within societal decision making frameworks, or within the science community itself. Similarly, “acceptable levels of impact” are difficult to define. Three examples are given to demonstrate the use of ecohydrological considerations for long-term sustainability of groundwater resources and their related ecosystem function. Such examples illustrate the importance of accommodating ecohydrogeological aspects into integrated groundwater management of the twenty-first century, regardless of society, climate, or setting.