Water resource planners and managers in the Mid-Atlantic United States typically determine the sufficiency of water supplies to meet demand by comparing (1) water use as reported to the state by individual water users to (2) metrics of water availability calculated from observed water monitoring networks. This paper focuses on determining whether this means of measuring water use is sufficient for proactive and sustainable management of water resources. The Potomac basin study area illustrates the point that, while state-reported water use databases typically cover the largest individual water users, unreported water uses can cumulatively comprise a substantial portion of the overall water use. If left unaccounted for, the system is vulnerable to human demand exceeding supplies, with attendant detrimental effects to aquatic habitats and organisms, especially given the exacerbating effects of climate change on the variability of water supplies. Planners and managers are therefore encouraged to consider the full spectrum of water uses, regardless of state reporting requirements.