Many of the world’s deltas are highly productive areas for agriculture as well as important places of socioeconomic development but are currently under stress. This study assesses the impacts of stresses on groundwater pumping, changing cropping patterns, and saltwater intrusion on groundwater resources in the Cauvery Delta in Tamil Nadu, India. A transient groundwater flow model of the delta was constructed for this assessment. The historical changes in groundwater resources in response to decreasing irrigation canal flows and increasing groundwater abstractions were assessed for the past 30 years. Furthermore, the model was used to formulate and analyze future sustainable groundwater development scenarios. Farmers’ narratives about a drying delta, as they experience water scarcity and quality issues most closely, were ascertained in the research. Farmers have abandoned many shallow wells in their fields. The model simulation shows groundwater levels are decreasing and aquifer storage depleting. Furthermore, salinization has increased, with continuous declining groundwater levels in the deep aquifer from 1990 to 2019. A more robust hydro-chemical assessment and further modeling of seawater intrusion are needed to better assess the sources and distribution of groundwater salinity. The pathway for future sustainability requires enhancing groundwater recharge in the shallow aquifer and controlling groundwater abstraction in the deep aquifers.