Groundwater is a valuable natural resource that needs to be assessed and protected. The European Union (EU) adopted new water legislation that includes the Water Framework Directive (WFD) and the Groundwater Daughter Directive (GWD). Both require the identification of sustained increasing pollution trends and their reversal. This is the second pillar of the WFD: such trends have to be identified for any pollutants that result in groundwater being characterized as at risk of not meeting the environmental objectives. Measuring these trends is necessary to determine and understand whether changes in land use, fertilizer application, pollution history, or climate change are affecting groundwater quality. However, in many cases, groundwater data series may not meet minimum requirements for classical statistical procedures employed in trend assessment: among other obstacles, data may be sparse, with missing or extreme values, censored data, seasonal effects, and autocorrelation. The aim of this chapter is to present and review several statistical methodologies that have been proposed and applied in recent years to deal with groundwater trend assessment, discussing the relative advantages and disadvantages of each one.