Cultures in Mediterranean climate zones (MCZs) around the world have long been reliant on groundwater and springs as freshwater sources. While their ecology and cultural sustainability are recognized as critically important, inter-relationships between springs and culture in MCZs has received little attention. Here we augmented a global literature review with case studies in MCZ cultural landscapes to examine the intensity of cultural and socio-economic impacts on springs ecohydrogeology. MCZs are often oriented on the west and southern coasts in tectonically active landscapes, which control aquifer structure, the prevalence of westerly winds, and aridity, and generally expose associated habitats to harsh, afternoon sunlight. Cultural appreciation and appropriation of springs ranges widely, from their use as subsitence supplies to profound traditions, such as Greco-Roman nymphs, and Asian and Abrahamic spiritual cleansing and baptism. Commoditization of water resources for agriculture, industry (e.g., mining, water bottling, geothermal resorts), and urban needs is placing ever-increasing, non-sustainable demands on aquifers and springs. When economic values approach or exceed cultural values, these irreplaceable aquatic resources are degraded and lost. Sustainable stewardship of springs and the aquifers that support them are a little-recognized, but central conservation challenge for modern society facing global climate changes.