Lake Tana, located in the headwaters of the Blue Nile, is valuable for many people including the communities who live around the lakeshore and those who live immediately downstream. The area has been identified as a region for hydropower and irrigation development, vital for economic growth in Ethiopia. A multidisciplinary study was conducted to assess the possible impacts of this development. This study found that current development has benefited some local people but adversely affected others. Future development will exacerbate pressure on the lake. Hard choices must be made about how the water is best utilized. It is important that all stakeholders, including local people, are involved in the decision-making process.