The human health risk associated with the ingestion of arsenic (As) contaminated groundwater as drinking water has been highlighted as the “largest mass-poisoning in human history.” Recently, secondary As exposure pathways have been identified through food and cattle products. Broad-based epidemiological estimation of the populations at risk is only available through statistical calculations, however, proper management needs community-level risk identification. Management strategies involve detection and monitoring, predictions, mitigations by standard and innovative technologies, and nature-based solutions for community drinking water supplies. Impacts of recent technological advancement in terms of real-time sensors and predictive modeling have outlined potential future possibilities. However, successful management would need to explore the nexus between 3-D contaminant occurrence over time, socio-economy, policy, and human behavior in delineating sustainable, clean water sources for sustainable development.