A rapid decline in water availability for crop production has driven substantial changes in cropping systems in the arid and semi-arid regions, including transitions from irrigated to dryland cropping. Management decisions play a critical role in the sustainability of agricultural systems facing transitions. Specifically, adopting practices that increase crop water use efficiency, improve soil health, and conserve water in the soil profile could improve agricultural sustainability. This review discusses published literature on the challenges associated with crop production and highlights management strategies to sustain soil health, enhance agricultural production, and farm profitability in the Ogallala Aquifer region to elucidate pathways to agricultural sustainability in water-limited environments around the world. We searched for published papers discussing soil health and water conservation practices, including conservation tillage, crop residue management, crop diversification, cover cropping, and livestock integration in cropping systems. These studies demonstrate adopting conservation systems can increase soil organic carbon (SOC) storage, water infiltration, soil microbial activities, water use efficiency, and decrease N fertilizer inputs compared to conventional systems. Integrating more than one soil and water conservation practice can complement to enhance soil health and sustainability of dryland or limited-irrigation agriculture in the Ogallala Aquifer region and similar agroecosystems across the world.