Water availability is endangering the production, quality, and economic viability of growing wine grapes worldwide. Climate change projections reveal warming and drying trends for the upcoming decades, constraining the sustainability of viticulture. In this context, a great research effort over the last years has been devoted to understanding the effects of water stress on grapevine performance. Moreover, irrigation scheduling and other management practices have been tested in order to alleviate the deleterious effects of water stress on wine production. The current manuscript provides a comprehensive overview of the advances in the research on optimizing water management in vineyards, including the use of novel technologies (modeling, remote sensing). In addition, methods for assessing vine water status are summarized. Moreover, the manuscript will focus on the interactions between grapevine water status and biotic stressors. Finally, future perspectives for research are provided. These include the performance of multifactorial studies accounting for the interrelations between water availability and other stressors, the development of a cost-effective and easy-to-use tool for assessing vine water status, and the study of less-known cultivars under different soil and climate conditions.