Abstract: Groundwater circulation in hilly coastal zones is a complex hydrogeological process controlled by “porous-fractured” heterogeneous aquifer medium. Under the combined influence of natural processes and anthropogenic activities, the the hierarchical nature of groundwater circulation and the associated environmental processes remain difficult to identify and quantify accurately. To provide a comprehensive overview of current advances in this field, this review systematically summarized characteristics and influencing factors of groundwater circulation, and synthesizes current knowledge on environmental behaviors and impact mechanisms of nitrogen, sulfur, and emerging contaminants driven by water circulation. The main understandings are as follows: (1) The aquifer media in hilly coastal zones present significant heterogeneity, leading to a multiscale nature of groundwater circulation. The complex medium structure and variable hydrodynamic conditions result in highly nonlinear characteristics of groundwater circulation. (2) Terrestrial pollutant inputs and land-sea hydrological interactions serve as the material basis and primary driving forces for nitrogen and sulfur cycling. Environmental factors such as salinity, organic matter, and redox potential regulate nitrogen and sulfur cycling by influencing microbial activity. (3) The migration and transformation of Pharmaceutically Active Compounds, per- and polyfluoroalkyl substances, and microplastics in groundwater of hilly coastal zones are primarily controlled by their adsorption properties, as well as external factors including topography, hydrodynamic conditions, sediment characteristics, and bioturbation. Accordingly, four key scientific questions requiring urgent attention in this field are proposed: the controlling mechanisms of porous-fractured heterogeneous aquifer systems on groundwater circulation; the driving mechanisms of multiscale groundwater circulation on nitrogen-sulfur biogeochemical processes; the migration and transformation mechanisms of emerging contaminants in heterogeneous media and different key interface; and the development of predictive models for environmental behaviors of biogenic elements and emerging contaminants applicable to heterogeneous coastal hilly zones. This review provides a theoretical basis for coastal zone water resource management and water environmental protection.