The artificial recharge of groundwater is a topic of growing interest. Artificial recharge utilizes alternative sources of water, including treated wastewater effluent, to augment natural recharge rates and slow water table declines. Artificial recharge can be accomplished through constructed infiltration basins with high infiltration rates to the water table, or injection wells screened at the depth of the aquifer bypassing the vadose zone. One emerging contaminant commonly detected in treated wastewater is antibiotics used to treat bacterial infections in humans and agriculture. Literature has shown that antibiotics can potentially modify the dissemination of antibiotic-resistant bacteria in the environment by augmenting horizontal gene transfer frequencies. Horizontal gene transfer is the exchange of antibiotic resistance, mainly through conjugation, from resistant bacteria to susceptible bacteria. While native subsurface bacteria are often resistant to antibiotics, they pose no direct risk to humans unless pathogens acquire that resistance. The potential modifications to the subsurface microbiome via the artificial recharge of treated wastewater have rarely been explored previously. This chapter aims to give an overview of artificial recharge, wastewater treatment, and bacterial and antibiotic transport in the subsurface influenced by artificial recharge. In addition, an existing artificial recharge site in El Paso, Texas, USA provides a model case for the evaluation of potential dissemination of environmental antibiotic resistance. Significant further research is required to determine the potential risks of spreading environmental antibiotic resistance resulting from the artificial recharge of treated wastewater.