Investments in drainage in irrigated agriculture are lagging well behind investments in irrigation. As a result, salinity and waterlogging problems now affect about 10–16% of these irrigated areas. To combat these problems and to cope with gradual changes in land use and a changing climate, the role of drainage has changed from a single-purpose measure for controlling waterlogging and/or salinity to an essential element of integrated water management under multiple land use scenarios. To give drainage its appropriate role in agricultural water management in irrigated agriculture, the current advances in drainage design and management are focussing on (i) creating more control, (ii) reducing the environmental effects of drainage, (iii) developing new materials and (iv) adapting the organization of drainage water management to increase farmer participation. In this chapter, these advances in drainage design and management are discussed with a focus on Egypt, a country with one of the largest drainage practices in the world.