Although changes in depth to groundwater occur naturally, anthropogenic alterations may exacerbate these fluctuations and, thus, affect vegetation reliant on groundwater. These effects include changes in physiology, structure, and community dynamics, particularly in arid regions where groundwater can be an important water source for many plants. To properly manage ecosystems subject to changes in depth to groundwater, plant responses to both rising and falling groundwater tables must be understood. However, most research has focused exclusively on riparian ecosystems, ignoring regions where groundwater is available to a wider range of species. Here, we review responses of riparian and other species to changes in groundwater levels in arid environments. Although decreasing water tables often result in plant water stress and reduced live biomass, the converse is not necessarily true for rising water tables. Initially, rising water tables kill flooded roots because most species cannot tolerate the associated low oxygen levels. Thus, flooded plants can also experience water stress. Ultimately, individual species responses to either scenario depend on drought and flooding tolerance and the change in root system size and water uptake capacity. However, additional environmental and biological factors can play important roles in the severity of vegetation response to altered groundwater tables. Using the reviewed information, we created two conceptual models to highlight vegetation dynamics in areas with groundwater fluctuations. These models use flow charts to identify key vegetation and ecosystem properties and their responses to changes in groundwater tables to predict community responses. We then incorporated key concepts from these models into EDYS, a comprehensive ecosystem model, to highlight the potential complexity of predicting community change under different fluctuating groundwater scenarios. Such models provide a valuable tool for managing vegetation and groundwater use in areas where groundwater is important to both plants and humans, particularly in the context of climate change.