The Author(s) 2019. Karez system is considered as the global human heritage since it is not only a traditional water supply system of exploiting groundwater, but also it reflects the culture, socio-economy, and history of the ancient civilizations that had utilized them for thousands of years in arid and semi-arid regions of the world. However, with the explosive population growth and rapid development of pumping technology in the last century, the karezes dried up or were abandoned as pumping wells lower the groundwater table. This poses a dilemma to policy makers whether to facilitate large-scale utilization of pumping well technology over karez system and treat karez as a cultural heritage which is non-functional for food production, or to keep using and preserving the karez system as a sustainable way of groundwater management as part of the integrated water supply systems in the arid regions. In this paper, we reviewed the historical, socio-economic, and cultural importance of karezes in the arid regions. We also discussed the distribution of karezes in the world, their unique geographical characteristics, technological advantages and limitations. We observed that the karez system is not only economically robust over the long term, but also a viable water supply technique for irrigation and domestic uses. The karezes should be protected as indigenous human heritage, and at the same time, they can be utilized as a sustainable way of water resources management in the arid regions to enhance water resiliency under changing environment.