Agricultural water pollution has far-reaching consequences on the environment, human health, and food security, impacting aquatic ecosystems and water quality. It is caused by contaminants such as fertilizers, pesticides, sediment, and others from both point and non-point sources. The global population growth and food consumption patterns increase the pressure on agriculture, making decisions to control pollution necessary. A comprehensive approach to integrated water quality management requires the participation of numerous organizations and stakeholders, including government agencies, NGOs, farmers, and others. It comprises the application of best management practices, alternative solutions, laws and regulations, research, and monitoring programs to reduce the effect of pollutants such as new toxins, metals, illnesses, organic matter, and pesticides. Future priorities in research include identifying the origins of pollution, exploring novel toxins, providing economic incentives for decreasing pollution, understanding the effect on biota, and gathering additional data. A healthy and sustainable ecosystem can be achieved through a combination of on-farm and off-farm responses, including integrated water resource management, conservation tillage and agroforestry, crop rotation and cover cropping, irrigation water management, and enhanced nutrient management and pesticide management, and precision agriculture technology. Regulations, technology usage, monitoring, and economic incentives should also be implemented to control and reduce the impact of agricultural water pollution.