Adaptive management (AM) uses targeted monitoring, and structured and iterative integration of new knowledge of project operations to improve future management practices. AM is increasingly cited in groundwater management plans because it purportedly overcomes inherent uncertainties in estimating future environmental responses to human activities. Yet, there are currently only general recommendations available for applying AM for groundwater management. In response, we develop preliminary guidance on the application of “adaptive groundwater management” (AGM) by amending existing AM theory to better account for the management challenges of groundwater-affecting activities. Three key factors emerge that are critical in the design of AGM strategies, including: (1) the severity of groundwater impacts from project operations, (2) the permanence of groundwater impacts, and (3) the level of uncertainty in groundwater system responses to project operations. These three factors are especially important considerations in stakeholder engagement and in assessing the applicability of AGM. The above three key factors are integrated into definitions of “active” and “passive” forms of AGM. Passive AGM strategies meet minimum thresholds for structured and iterative management approaches that incorporate uncertainty reduction, while active AGM strategies include additional constraints that place a greater emphasis on uncertainty quantification and reduction. The preliminary guidance on AGM given in this paper should be extended through consultation with groundwater industry groups and regulators to urgently develop formal AGM guidelines, thereby improving awareness and accountability of the risks and manageability of future groundwater impacts.