A synthesis of groundwater ages, recharge rates and information on processes affecting groundwater quality in northern China highlights the major challenges faced for sustainable management of the region's groundwater. Direct recharge rates range from hundreds of millimetres per year in the North China Plain, to tens of millimetres per year in the Loess Plateau to less than 4 mm/year in the arid northwest. Recharge rates and mechanisms to deep semiconfined and confined aquifers are poorly constrained; however, on the basis of available data, these are likely to be mostly negligible. Severe groundwater level declines (0.5–3 m/year) have occurred throughout northern China in the last three to four decades, particularly in deep aquifers. Radiocarbon dating, stable isotope and noble gas data show that the most intensively extracted deep groundwater is palaeowater, recharged under different climate and land cover conditions to the present. Reservoir construction has reduced surface runoff in mountain-front areas that would naturally recharge regional Quaternary aquifers in many basins. In combination with intensive irrigation practices, this has resulted in the main recharge source shifting from surface runoff and mountain-front recharge to irrigation returns. This has reduced infiltration of fresh recharge at basin margins and rapidly increased nitrate concentrations and overall mineralisation in phreatic groundwater over wide areas (in some cases to >400 mg/l and >10 g/l, respectively). In some basins, there is evidence that poor quality shallow water has leaked into deep layers (>200 m) via preferential flow, mixing with palaeowaters stored in semiconfined aquifers. High concentrations of naturally occurring fluoride and arsenic (locally >8.5 and >4 mg/l, respectively) have recently lead to the abandonment of numerous supply wells in northern China, creating further pressure on stressed water resources. Increasing water demand from direct and indirect consumption poses major challenges for water management in northern China, which must consider the full water cycle. Copyright © 2012 John Wiley & Sons, Ltd.