This article reviews the state of the art with respect to the environmental effects of irrigated agriculture on water and soil quality in arid and semi-arid regions on a field scale. Information is scarce and fragmentary. Examples in selected areas of other arid and semi-arid regions in the world clearly show the importance of studying the environmental impact of irrigation practices on water and soil quality. Studies mainly refer to waterlogging and salinization. As regards agrochemicals, fertilizers have been taken into account through nitrate leaching. The impact of micropollutants such as pesticides and heavy metals on water and soil quality is studied mainly by modeling. Pharmaceutical compounds emerge as pollutants when wastewater is used for irrigation without any previous treatment, situation which is now the object of new studies. There is an obvious need to study in-depth knowledge related to appropriate technologies for the use, treatment, and reuse of wastewater which is a valuable resource in arid and semi-arid regions.