In this paper, we compare the changes of reservoir storage capacity, the increase of irrigation area, and evolution of water utilization structure between China and the USA, and compare the data of water resources exploitation of China with those of several major countries. We conclude that China's total water utilization volume will continuously increase in the next 20 years, driven by the rigid growth of agricultural water utilization, household water utilization, and ecological water utilization. We also present the countermeasures and suggestions, which include strengthening the water resources exploitation, carrying out large-scale western route projects of the South-to-North Water Diversion Project, improving the utilization efficiency of water resources in the northwestern regions, and making overall plans for the ecological water utilization in the northwestern regions, in order to achieve multiple-win outcomes involving the land and water resources exploitation in western China, poverty alleviation, and the improvement of the ecological environment.