Agriculture is still by far the largest consumer of water in China. However, industrial, urban and now environmental water uses are rapidly growing. While in the past these new water needs could have been met through additional development or allocations, today scarcity – in terms of quantity, quality or both – means that new utilization often comes at the expense of other uses, in particular agricultural. The increasing pressure on agricultural water use comes at a time when rural poverty reduction and national food security are major national goals. The key questions are thus whether and how policy reform can contribute to changes in water use which maintain agricultural production and enhance rural livelihoods while at the same time freeing water for new, higher value uses outside the agricultural sector. This paper provides both an overview of the major issues behind these questions as well as a synthesis of the papers included in this special issue and their insights into the answers to those questions.