Groundwater utilization and groundwater quality vary in the Baltic and Nordic countries mainly because of different geological settings. Based on the geology, the countries were treated in the following three groups: (1) Fennoscandian (Finland, Sweden, and Norway) countries, (2) Denmark and Baltic (Estonia, Latvia, and Lithuania) countries, and (3) Iceland. Most of the utilized groundwater resources are taken from Quaternary deposits, but Denmark and the Baltic countries have in addition, important resources in Phanerozoic rocks. The groundwater quality reflects the residence time of water in the subsurface and the chemical composition of the geological formations. Concentrations of ions in the Fennoscandian bedrock are elevated compared to Iceland, but lower than in Denmark and the Baltic countries. Compared to groundwater in the bedrock, groundwater in Quaternary deposits has usually lower concentrations of dissolved minerals. Unconfined Quaternary aquifers are vulnerable to contamination. Examples from Denmark and the Baltic countries illustrate challenges and successful effects of mitigation strategies for such aquifers related to agricultural application and management of nitrogen. Confined and deeper groundwater is better protected against anthropogenic contamination, but water quality may be affected by harmful compounds caused by geogenic processes (namely, sulfide, arsenic, fluoride, and radon).