To evaluate the effects of nitrogen (N) and irrigation coupling on the soil N distribution, plant N utilization, and fruit yield of rabbiteye blueberries (Vaccinium virgatum), a field experiment was designed using two factors (water and fertilizer application) with four levels of irrigation and three levels of fertilization, and a control. Under the different water and fertilizer combinations, N primarily accumulated in the leaves. Irrigation and N application within appropriate ranges (pure N ≤ 29 g/plant and irrigation volume ≤ 2.5 L/plant) significantly improved the blueberry fruit yield. Increases in water and N within these ranges promoted the effective accumulation of N in various organs and the absorption and utilization of N in the plants, which ultimately promoted blueberry yield. With increased N application rate, the nitrate N content of the 0–20 cm and 20–50 cm soil layers increased. With increased irrigation volume, the nitrate N content of the 0–20 cm soil layer decreased, while the nitrate content in the 20–50 cm soil layer increased. Low N and moderate water treatments resulted in high fruit yields and reduced nitrate N retention in the soil. Under these conditions, the economic input-output ratio was high and the soil N accumulation was low, and thus the economic and ecological benefits were maximized.