Synthesizing binational data to characterize shared water resources is critical to informing binational management. This work uses binational hydrogeology and water resource data in the Mesilla/Conejos-Médanos Basin (Basin) to describe the hydrologic conceptual model and identify potential research that could help inform sustainable management. The Basin aquifer is primarily composed of continuous basin-fill Santa Fe Group sediments, allowing for transboundary throughflow. Groundwater flow, however, may be partially or fully restricted by intrabasin uplifts and limited recharge. The shallow groundwater in the Rio Grande alluvium receives recharge from the Rio Grande and responds to changes in water supply and demand. About 11% of Rio Grande alluvial groundwater volume is recharged annually, an amount that is less than recent withdrawals. Potentially recoverable fresh to slightly brackish groundwater was estimated at 82,600 cubic hectometers in the U.S. portion of the Basin and 69,100 cubic hectometers in the Mexican portion. Alluvial groundwater geochemistry is governed by the evaporative concentration of the Rio Grande and agricultural diversions, whereas deeper groundwater geochemistry is governed by mixing and geochemical processes. Continued refinements to storage estimates, the water budget, and deep groundwater extent and geochemistry can improve estimates of sustainable use and inform alternative water sources.