Efforts to improve water quality and quantity, and sanitation in the world are impeded by a variety of technical and socioeconomic issues often unfamiliar to well-motivated individuals. Sustainable technological improvement can be thwarted by the lack of consideration of regional norms, customs, mores, and traditions, and by the absence of feasibility assessment and coordination with the community both before and during instatement of local improvements. Specifically, the absence of coordination means not fully allowing users to define their needs, resources, issues, and maintainable solutions, and not understanding local and regional power dynamics and the ability of the community to provide long-term project stewardship. Other mistakes can include: a lack of long-term planning; inadequate scientific and engineering design and construction; lack of anticipation of contingencies and complicating issues and lack of adaptive management to deal with these unforeseen events; use of inappropriate technology; absence of educational efforts (both for the community to understand and provide stewardship for the project, and for the education of those installing the facilities in the community); lack of follow-up; and lack of technical expertise and leadership. There is no single approach to water and sanitation development that fits all situations. However, avoiding common pitfalls can bring these important resources to villages worldwide, and in the process empower communities, reduce sickness and mortality, and improve the human condition.