U.S. agricultural productivity has doubled over the past 50 years, but water quality improvement has been minimal despite increased efficiency. This paper reviews the processes, conservation practices, and programs influencing agriculture's impact on surface and groundwater quality, examining the complexities of nutrient cycling, management trade-offs, and federal conservation program effectiveness. Key needs identified include more precise nutrient recommendations, improved water monitoring methods, novel conservation practices addressing dissolved nutrient loss, and greater cost-effectiveness through regional and industry collaboration.