The rapid depletion of US groundwater resources and rising number of dying wells in the Western US brings attention to the significance of groundwater governance and sustainability restrictions. However, such restrictions on groundwater withdrawals are likely to generate spillover effects causing further environmental stresses in other locations and adding to the complexity of sustainability challenges. The goal of this paper is to improve our understanding of the implications of growing global food demand for local sustainability stresses and the implications of local sustainability policies for local, regional, and global food production, land use, and prices. We employ SIMPLE-G-US (Simplified International Model of agricultural Prices, Land use, and the Environment—Gridded version for the United States) to distangle the significance or remote changes in population and income for irrigation and water resources in the US. Then we examine the local-to-global impacts of potential US groundwater sustainability policies. We find that developments in international markets are significant, as more than half of US sustainability stresses by 2050 are caused by increased commodity demand from abroad. Furthermore, a US sustainable groundwater policy can cause overseas spillovers of US production, thereby potentially contributing to environmental stresses elsewhere, even as groundwater stress in the US is alleviated. These unintended consequences could include deforestation due to cropland expansion, as well as degradation in water quality due to intensification of production in non-targeted areas.