Conjunctive use (CU) of surface and groundwater storage and supplies is essential for integrated water management. It is also a key strategy for supporting groundwater-dependent ecosystems, and for adapting water systems to future climate and land use changes. CU has become increasingly sophisticated and integrated with other innovative and traditional water management techniques, such as water transfers, water reuse, demand management, and aquifer remediation. CU adds value for society (increasing average yield and reliability) but can also induce costs to some parties, such as damaging senior water rights of surface water users when pumping from the aquifer reduces streamflow. Groundwater overexploitation also can produce a host of undesirable economic and environmental impacts. Successful CU implementation typically requires changes in infrastructure and operations, but also changes in institutions and institutional arrangements to offset potential third party costs and protect ecosystems. This chapter analyses first the management and economic implications of CU,