An underground aqueduct is usually a canal built in the subsurface to transfer water from a starting point to a distant location. Systems of underground aqueducts have been applied by ancient civilizations to manage different aspects of water supply. This research reviews underground aqueducts from the prehistoric period to modern times to assess the potential of achieving sustainable development of water distribution in the sectors of agriculture and urban management, and provides valuable insights into various types of ancient underground systems and tunnels. The review illustrates how these old structures are a testament of ancient people’s ability to manage water resources using sustainable tools such as aqueducts, where the functionality works by using, besides gravity, only “natural” engineering tools like inverted siphons. The study sheds new light on human’s capability to collect and use water in the past. In addition, it critically analyzes numerous examples of ancient/historic/pre-industrial underground water supply systems that appear to have remained sustainable up until recent times. The sustainability of several underground structures is examined, correlated to their sound construction and regular maintenance. Moreover, several lessons can be learned from the analysis of ancient hydraulic works, particularly now, as many periodically hydrologic crises have occurred recently, overwhelmingly impacted by climate change and/or over-exploitation and degradation of available water resources.