Engineered rivers in arid lands play an important role in feeding the world’s growing population. Each continent has rivers that carry water from distant mountain sources to fertile soil downstream where rainfall is scarce. Over the course of the last century most rivers in arid lands have been equipped with large engineering structures that generate electric power and store water for agriculture and cities. This has changed the hydrology of the rivers. In this paper we discuss how climate variation, climate change, reservoir siltation, changes in land use and population growth will challenge the sustainability of engineered river systems over the course of the next few decades. We use the Rio Grande in North America, where we have worked with Mexican and American colleagues, to describe our methodology and results. Similar work is needed to study future water supply and demand in engineered rivers around the world.