The purpose of this document is to brief policy makers about the impact of unmet water and sewer needs on health and the quality of life in rural Alaska. A strategic plan, new approaches and funding are needed to maintain existing structures and resolve the challenges of hard-to-serve communities with appropriate technology. There are novel technologies and approaches to water preparation, recycling and sewage treatment in development. We urge you to acquaint yourself with these issues; recognize the importance of adequate quantities of quality water and efficient waste management systems; and commit to ensuring that these issues are resolved.