The twin environmental problems of water quality and water quantity are acute in the Yellow River basin. With only about 2% of the total water resources in China, the basin accounts for 17% of agricultural lands and 8% of national population. Therefore, the Yellow River basin faces critical water issues such as water scarcity, intersectoral water allocations, water pollution, and conflict with economic development. In this chapter, the spatial and temporal variation of water resources in the Yellow River basin are examined. Furthermore, the natural and anthropogenic factors affecting the water quantity and quality are explored. Finally, the strategies for water management sustainability in the basin is discussed.