This publication provides an overview of the problem of affordability of wastewater utility bills and offers specific considerations that elected officials, utility managers, and utility staff might take into account when addressing affordability issues in their communities. This includes defining and measuring affordability, highlighting what features might be included in an assistance program for those unable to pay for basic service levels, identifying the primary targets for an assistance program and determining eligibility, listing possible performance measures for providing this assistance, and offering some case studies from communities that have been leaders in attempting to tackle these difficult issues. Affordability concerns affect customers, utilities, and the entire local community. Because of the relatively rapid increases in wastewater infrastructure costs and rates to address aging infrastructure—both now now and likely into the future—this topic is more timely and important than ever before.