In arid and semi-arid regions, groundwater is often the only available water source. However, overexploitation and pollution have led to a decrease in groundwater quantity and quality. Therefore, the proper management of groundwater resources is essential to promote sustainable development. Numerical simulation models (NSMs) have emerged as a valuable tool to address these challenges due to their ability to accurately and efficiently model groundwater systems. This study provides a comprehensive systematic review to evaluate the current knowledge on using numerical groundwater flow models for planning and water resource management in countries in the American region. A total of 166 research articles were published between the years 2000 and 2024. We analyzed and summarized details such as the study regions, numerical simulation methods and applied software, performance metrics, modeling units, modeling limitations, and prediction scenarios. In addition, we discuss alternatives to address the constraints and difficulties and suggest recommendations for future research. The continued research, improvement, and development of numerical groundwater models are essential to ensure the sustainability of groundwater resources.