Water is the defining issue in determining the development and growth of human populations of the Southwest. The cities of Las Vegas, Phoenix, Tucson, Albuquerque, and El Paso have experienced rapid and exponential growth over the past 50 years. The outlook for having access to sustainable sources of water to support this growth is not promising due to water demand and supply deficits. Regional water projects have harnessed the Colorado and Rio Grande rivers to maximize the utility of the water for human consumption and environmental laws have been adopted to regulate the beneficial use of this water, but it still is not enough to create sustainable future for rapidly growing southwest cities. Future growth in these cities will depend on finding new sources of water and creative measures to maximize the utility of existing water resources. The challenge for southwest cities is to establish policies, procedures, and projects that maximizes the use of water and promotes conservation from all areas of municipal users. All cities are faced with the same challenges, but have different options for how they prioritize their water resources. The principal means of sustainable water management include recovery, recharge, reuse, and increasing the efficiency of water delivery. Other strategies that have been adopted include harvesting of rainwater, building codes that promote efficient water use, tiered water rates, turf removal programs, residential water auditing, and native plant promotion. Creating a sustainable future for the southwest will best be achieved by cities that adopt an integrated approach to managing their water resources including discouraging discretionary uses of water, adoption of building and construction codes for master plans, industrial plants, and residential construction. Additionally, a robust plan for education of the public is essential to create a culture of conservation from a very young age.