The Mediterranean area is undergoing intensive demographic, social, cultural, economic, and environmental changes. This generates multiple environmental pressures such as increased demand for water resources, generation of pollution related to wastewater discharge, and land consumption. In the Mediterranean area, recent climate change studies forecast large impacts on the hydrologic cycle. Thus, in the next years, surface and ground-water resources will be gradually more stressed, especially in coastal areas. In this review paper, the historical and geographical distribution of peer-review studies and the main mechanisms that promote aquifer salinization in the Mediterranean area are critically discussed, providing the state of the art on topics such as actual saltwater wedge characterization, paleo-salinities in coastal areas, water-rock interactions, geophysical techniques aimed at delineating the areal and vertical extent of saltwater intrusion, management of groundwater overexploitation using numerical models and GIS mapping techniques for aquifer vulnerability to salinization. Each of the above-mentioned approaches has potential advantages and drawbacks; thus, the best tactic to tackle coastal aquifer management is to employ a combination of approaches. Finally, the number of studies focusing on predictions of climate change effects on coastal aquifers are growing but are still very limited and surely need further research.