In many coal mines, limestone-confined aquifers underlie coal seams. During coal extraction from these mines, water inrushes occur frequently with disastrous consequences. This paper introduces the hydrogeological conditions of the coal mines and the potential water inrush disasters from aquifers under coal seams. It then presents the water inrush mechanism. The main factors which control water inrushes include strata pressure, mining size, geologic structures and the water pressure in the underlying aquifer. Analysis shows that reduction of confinement due to mining is the major cause of the water-conducting failure in the floor strata. The depth of the failure zone is strongly dependent on the mining width. This paper also presents field observation results of the water-conducting failure in the floor strata, and applies the finite element method coupled with stress-dependent permeability to analyze hydraulic conductivity enhancement due to coal extraction. Finally, theoretical and empirical methods to predict water inrushes are given, and technical measures for improving mine design and safety for coal extraction over aquifers are presented. These measures include fault and fracture grouting and mining method modification such as changing long-wall to short-wall mining.