Energy and water are interlinked. The development, use, and waste generated by demand for both resources drive global change. Managing them in tandem offers potential for global-change adaptation but presents institutional challenges. This paper advances understanding of the water-energy nexus by demonstrating how these resources are coupled at multiple scales, and by uncovering institutional opportunities and impediments to joint decision-making. Three water-energy nexus cases in the United States are examined: (1) water and energy development in the water-scarce Southwest; (2) conflicts between coal development, environmental quality, and social impacts in the East; and (3) tensions between environmental quality and economic development of shale natural gas in the Northeast and Central U.S. These cases are related to Eastern, Central, and Western regional stakeholder priorities collected in a national effort to assess energy-water scenarios. We find that localized challenges are diminished when considered from broader perspectives, while regionally important challenges are not prioritized locally. The transportability of electricity, and to some extent raw coal and gas, makes energy more suitable than water to regionalized global-change adaptation, because many of the impacts to water availability and quality remain localized. We conclude by highlighting the need for improved coordination between water and energy policy. (C) 2011 Elsevier Ltd. All rights reserved.