Ground source heat pumps (GSHPs) gained increasing interest owing to benefits such as low heating and cooling costs, reduction of greenhouse gas emissions, and no pollutant emissions on site. However, GSHPs may have various possible interactions with underground and groundwater, which, despite the extremely rare occurrence of relevant damages, has raised concerns on their sustainability. Possible criticalities for their installation are (hydro)geological features (artesian aquifers, swelling or soluble layers, landslide-prone areas), human activities (mines, quarries, landfills, contaminated sites), and groundwater quality. Thermal alterations due to the operation of GSHPs may have an impact on groundwater chemistry and on the efficiency of neighboring installations. So far, scientific studies excluded appraisable geochemical alterations within typical ranges of GSHPs (±6 K on the initial groundwater temperature); such alterations, however, may occur for aquifer thermal energy storage over 40 • C. Thermal interferences among neighboring installations may be severe in urban areas with a high plant density, thus highlighting the need for their proper management. These issues are presented here and framed from a groundwater quality protection perspective, providing the basis for a discussion on critical aspects to be tackled in the planning, authorization, installation, and operation phase. GSHPs turn out to be safe and sustainable if care is taken in such phases, and the best available techniques are adopted.