In rural north-western China, the tension between economic growth and ecological crises demonstrates the limitations of dominant top-down approaches to water management. In the 1990s, the Chinese government adopted the Integrated Water Resources Management (IWRM) approach to combat the degradation of water and ecological systems throughout its rural regions. While the approach has had some success at reducing desertification, water shortage, and ecological deterioration, there are important limitations and obstacles that continue to impede optimum outcomes in water management. As the current IWRM approach is instituted through a top-down centralized bureaucratic structure, it often fails to address the socio-political context in which water management is embedded and therefore lacks a complete treatment of how power is embedded in the bureaucracy and how it articulates through economic growth imperatives set by the Chinese state. The approach has relied on infrastructure heavy and technocratic solutions to govern water demand, which has worked to undermine the focus on integration and public participation. Finally, the historical process through which water management mechanisms have been instituted are fraught with bureaucratic fragmentation and processes of centralization that work against some of its primary goals such as reducing uncertainty and risk in water management systems. This article reveals the historical, social, political, and economic processes behind these shortcomings in water management in rural north-western China by focusing on the limitations of a top-down approach that rely on infrastructure, technology, and quantification, and thereby advances a more holistic, socio-political perspective for water management that considers the state-society dynamics inherent in water governance in rural China.