Most people living in the United States take for granted that they have reliable systems to supply clean water and take away wastewater. However, over 2 million Americans lack access to adequate water sanitation systems, exposing them to unsafe conditions and leading to the rise of neglected diseases such as hookworm and cholera that are generally associated with developing countries. As many as 25% of homes in the United States, mostly in rural areas, are not connected to centralized water treatment facilities and instead use onsite household sanitation systems. Underground septic tanks and drainfields serve many households well, but can be hindered by issues with geology and installation, leading some households to resort to straight pipe sewers that discharge directly onto adjoining land. Low performing systems primarily affect low-income communities and communities of color. The lack of basic water access in turn impacts the health and livelihood of these communities, creating a vicious cycle of poverty. The issues that have led to gaps in sanitation access are multi-fold and include social, economic, and political factors, in addition to geological, ecological, and technical factors. In this panel, we will hear from speakers with science, engineering, and policy backgrounds who are working with rural communities on solutions to address local water needs.