ABSTRACT Rapid recent expansion of artisanal and small‐scale gold mining (ASGM) globally has led to widespread impacts on water. ASGM often occurs within or adjacent to communities, directly impacting the people who live there. We performed an extensive review of scholarship to document the myriad ways ASGM impacts water and thus humans and ecosystem health. Drawing from > 300 peer‐reviewed articles, books, and government reports, we examine how ASGM uses water in both alluvial and hard rock mining. We report impacts of ASGM on water distribution and water quality. We also link ASGM‐water processes to human health, including impacts on disease dynamics, drownings and water‐related accidents, local water insecurity, and mental health. We conclude by identifying remaining gaps in the scholarship around ASGM and water, including the need for research on hard rock mining, household water insecurity, disease transmission beyond malaria, and fluvial geomorphology. Finally, we show that the short‐term and transient nature of many ASGM activities contrast with the resultant long‐term and widespread impacts. While gold mining is framed as being vital to national economies and employment, the long‐term implications (e.g., mercury contamination, increased malarial transmission, artificial lake formation, farm destruction) are profound. Policy makers, government officials, and others should consider the long‐term environmental, social, and health impacts of ASGM on water resources to fuel development and enforcement of more sustainable policies and regulations. This article is categorized under: Science of Water > Water and Environmental Change Engineering Water > Water, Health, and Sanitation Science of Water > Water Quality