Mountain water resources are of particular importance for downstream populations but are threatened by decreasing water storage in snowpack and glaciers. Groundwater contribution to mountain streamflow, once assumed to be relatively small, is now understood to represent an important water source to streams. This review presents an overview of research on groundwater in high mountain environments (As classified by Meybeck et al. (2001) as very high, high, and mid-altitude mountains). Coarse geomorphic units, like talus, alluvium, and moraines, are important stores and conduits for high mountain groundwater. Bedrock aquifers contribute to catchment streamflow through shallow, weathered bedrock but also to higher order streams and central valley aquifers through deep fracture flow and mountain-block recharge. Tracer and water balance studies have shown that groundwater contributes substantially to streamflow in many high mountain catchments, particularly during lowflow periods. The percentage of streamflow attributable to groundwater varies greatly through time and between watersheds depending on the geology, topography, climate, and spatial scale. Recharge to high mountain aquifers is spatially variable and comes from a combination of infiltration from rain, snowmelt, and glacier melt, as well as concentrated recharge beneath losing streams, or through fractures and swallow holes. Recent advances suggest that high mountain groundwater may provide some resilience-at least temporarily-to climate-driven glacier and snowpack recession. A paucity of field data and the heterogeneity of alpine landscapes remain important challenges, but new data sources, tracers, and modeling methods continue to expand our understanding of high mountain groundwater flow.