Groundwater (GW), which accounts for 97% of the world’s freshwater, is vital for sustaining ecosystems and providing drinking water for millions. However, fluoride (F) contamination in GW poses a significant environmental and public health issue globally. This chapter talks about these important issues and looks at both natural and industrial sources of pollution. It talks about how minerals like fluorite, apatite, cryolite, and amphibole are weathered and used in industries like making bricks and ceramics, smelting aluminum, burning fossil fuels, and making phosphate fertilizer. Factors such as climate change, sedimentary formations, arid regions, and seawater intrusion further exacerbate F levels in GW. High concentrations of F in GW led to severe health risks, including dental and skeletal fluorosis, cognitive impairment, and kidney and thyroid dysfunction. Additionally, F contamination disrupts ecosystems and biodiversity by affecting plants and aquatic life. To mitigate these risks and restore water quality, the chapter discusses various strategies, including natural attenuation, myco-phyco-phyto remediation, membrane filtration, ion exchange, precipitation, and adsorption using materials like activated alumina and biochar. This synthesis of scientific research and practical interventions emphasizes biotechnological approaches and underscores the importance of interdisciplinary collaboration involving fields such as environmental science, public health, and engineering. Effective mitigation measures are essential to protect human health and ensure environmental sustainability. The chapter highlights the need for continued research, proactive management, and policy development to address F contamination in GW comprehensively.