The United States (US)—contrary to reports of 100 percent access to safe water and sanitation in international surveys—has a complex landscape of low-income water problems. Also, during the late-20th century, the US has had a declining role in international water programs providing infrastructure and monitoring to support access and sanitary conditions. This has contributed to limited international awareness of low-income water programs in the US, and has limited US awareness of low-income water issues. On the one hand, these trends reflect dramatic historical improvements in water and sanitation during the 20th century, for the poor as well as those better off, and this has relevance for international programs. Close inspection indicates that the US has significant geographic areas of low-income water problems that warrant attention, and a study of comparable problems and approaches would be of benefit locally and internationally. This