Water was perceived as a key resource for the socio-economic development of the region when it was part of the Soviet Union and continues to be perceived as such by the independent states of Central Asia (CA). The expansion of intensive and wasteful irrigated farming during the Soviet period was an outcome of this thinking, and the main cause of the drying-up of the Aral Sea. Even after independence in 1991, 90 percent of the total water withdrawn in CA is still used for irrigated agriculture. Water shortages experienced in the past, but also today, are the result not of limitations in the physical availability of water, but rather of wasteful practices coupled with intra-regional and inter-sectoral competition for water. Water use for agriculture and other sectors is less coordinated today because of the emergence of nation-states and because of the transition from collective to individual farming. A major conflict exists between countries and sectors, i.e., between upstream and downstream countries over the allocation of water for agriculture and for energy production. Additional challenges are posed by climate change, rural outmigration and by the environmental impact of the mining sector. Sustainable water management requires intra-regional cooperation and integrated approaches to rural development. There is growing scientific interest to explore the food-water-energy-mining nexus to incorporate conflicting interests of different sectors/countries and enhance understanding of water use interconnectedness.