Recently, much attention has been focused on insecticides as a group of chemicals combining high toxicity to invertebrates and fishes with low application rates, which complicates detection in the field. Assessment of these chemicals is greatly facilitated by the description and understanding of exposure, resulting biological effects, and risk mitigation strategies in natural surface waters under field conditions due to normal farming practice. More than 60 reports of insecticide-compound detection in surface waters due to agricultural nonpoint-source pollution have been published in the open literature during the past 20 years, about one-third of them having been undertaken in the past 3.5 years. Recent reports tend to concentrate on specific routes of pesticide entry, such as runoff, but there are very few studies on spray drift-borne contamination. Reported aqueous-phase insecticide concentrations are negatively correlated with the catchment size and all concentrations of > 10 microg/L (19 out of 133) were found in smaller-scale catchments (< 100 km2). Field studies on effects of insecticide contamination often lack appropriate exposure characterization. About 15 of the 42 effect studies reviewed here revealed a clear relationship between quantified, non-experimental exposure and observed effects in situ, on abundance, drift, community structure, or dynamics. Azinphos-methyl, chlorpyrifos, and endosulfan were frequently detected at levels above those reported to reveal effects in the field; however, knowledge about effects of insecticides in the field is still sparse. Following a short overview of various risk mitigation or best management practices, constructed wetlands and vegetated ditches are described as a risk mitigation strategy that have only recently been established for agricultural insecticides. Although only 11 studies are available, the results in terms of pesticide retention and toxicity reduction are very promising. Based on the reviewed literature, recommendations are made for future research activities.