In many parts of the world, climate change has already caused a decline in groundwater recharge, whereas groundwater demand for drinking water production and irrigation continues to increase. In such regions, groundwater tables are steadily declining with major consequences for groundwater-surface water interactions. Predominantly gaining streams that rely on discharge of groundwater from the adjacent aquifer turn into predominantly losing streams whose water seeps into the underground. This reversal of groundwater-surface water interactions is associated with an increase of low river flows, drying of stream beds, and a switch of lotic ecosystems from perennial to intermittent, with consequences for fluvial and groundwater dependent ecosystems. Moreover, water infiltrating from rivers and streams can carry a complex mix of contaminants. Accordingly, the diversity and concentrations of compounds detected in groundwater has been increasing over the past decades. During low flow, stream and river discharge may consist mainly of treated wastewater. In losing stream systems, this contaminated water seeps into the adjoining aquifers. This threatens both ecosystems as well as drinking and irrigation water quality. Climate change is therefore severely altering landscape water balances, with groundwater-surface water-interactions having reached a tipping point in many cases. Current model projections harbor huge uncertainties and scientific evidence for these tipping points remains very limited. In particular, quantitative data on groundwater-surface water-interactions are scarce both on the local and the catchment scale. The result is poor public or political awareness, and appropriate management measures await implementation.