This article highlights the struggles many rural communities throughout the U.S. have in accessing clean and reliable water for drinking and sanitation. Many small water systems in rural and poor areas struggle to adequately deliver services, maintain pipes, and expand infrastructure; this is especially prevalent on indigenous reservations and areas along the Mexican border. Some small water systems also operate miles worth of faulty pipes and lead infrastructure, potentially poisoning thousands of residents. Towns and cities in unincorporated regions of states sometimes struggle to access federal funding and enforce water regulations, further challenging water provider’s attempts to deliver clean water to those in need. Overall, many marginalized regions must overcome institutional barriers if they want to adequately provide customers with reliable water infrastructure.