Karst aquifers, capable of storing and transmitting large amount of water, are the main source of drinking water in many regions worldwide. Their excessive permeability leads to an enhanced vulnerability to retain and spread the contamination accordingly. From sustainability perspective, the environmental, economic and social impacts of karst contamination on water resources management are gaining more attention. In this study, an overview of hydrogeological processes and concepts regarding groundwater flow and contaminant transport in karstic systems is presented, followed by a short discussion on surface water and groundwater interaction. Due to the complexity of karstic systems, different approaches have been developed by researchers for investigating and understanding hydrogeological processes and groundwater behavior in karst which are reviewed herein. Additionally, groundwater contamination issues and the most common and effective remediation techniques in karstic terrains are discussed. Lastly, modeling techniques and remote sensing methods, as beneficial and powerful tools for assessing groundwater flow and contaminant transport in karst terrains, are reviewed and evaluated. In each section, relevant research works conducted for Puerto Rico are discussed and some recommendations are presented to complement the ongoing hydrogeological investigations on this island.