The presence of arsenic and boron in drinking water represents a critical public health concern, particularly in regions with hydrogeochemical conditions conducive to their mobilization or where anthropogenic activities exacerbate their release. This study examines the sources, hydrogeochemical behavior, exposure pathways, and associated risks of both elements, integrating key indicators such as Estimated Daily Intake (EDI), Hazard Quotient (HQ), and Cancer Risk (CR). Documented cases worldwide are reviewed, highlighting the co-occurrence of arsenic and boron in arid and high-Andean regions, as well as their impacts on communities lacking access to advanced treatment. Furthermore, removal technologies including coagulation–filtration, adsorption, reverse osmosis, nanofiltration, electrodialysis, and hybrid systems are assessed, alongside successful implementation experiences and lessons learned. Technical and economic limitations are identified, emphasizing the need to integrate technological solutions with public policies, real-time monitoring, and community engagement. Finally, research lines are proposed focusing on the development of low-cost, high-efficiency materials and on strengthening international cooperation to ensure universal access to safe drinking water.