The aim of this study is to address the problem of balance between water scarcity and sustainability, which are the key components of water security of cities located in arid lands, particularly those under constant expansion and population growth. In this paper, we have highlighted the problem of water security for the sustainability of the La SerenaCoquimbo conurbation (LSCC). The coastal LSCC is located at the outlet of the Elqui River basin, in the southern edge of the Chilean Atacama Desert. We have analyzed the available information including drinking water production and consumption data, groundwater levels, precipitation data and population data. Between the years 2009 and 2013 the total water consumption for the area has significantly increased. On the other hand, there has been a significant decrease trend in the precipitations and the groundwater levels show a decrease of about 30 m between the years 1995 and 2014. In a few years, this urban area could face a general water scarcity problem if the drought conditions remain unchanged and if the water demand trend for the agricultural, mining and drinking water continues its increasing. The cities located in the arid lands are particularly vulnerable to water scarcity because their populations are highly concentrated and requires reliable supplies of water to make possible human and economic activities. We discuss how adaptation of the arid land urban areas to water scarcity requires a range of solutions, including economic incentives, regulatory measures, and technology.