Given that food production relies heavily on land and water, any policy to restrict water and land use will immediately raise concerns about local economic activity and global food security. This chapter explores both of these dimensions of global groundwater sustainability policy. In so doing, we highlight the importance of market-mediated spillover effects stemming from locally targeted policies. Using a multi-scale, multi-system framework integrating economic and biophysical determinants of sustainability, we find that the local economic impacts of a groundwater sustainability policy are often substantial. However, due to market-mediated responses—including surface water substitution, expansion of rainfed production, relocation, and virtual trade in blue water—the final impact on global food prices and production is surprisingly modest.