In recent decades urban water services have been confronted by new challenges questioning their sustainability. As detailed in previous chapters of this book, there have been environmental issues and climate change issues which require more efficient use of energy and water resources; and now the rise of ‘water poverty’ provokes renewed interest into social sustainability. At the same time, full cost recovery is broadly advocated, public subsidies are coming to an end, precisely when water services are facing calls for huge investment to renew their assets. Technical, economic, and social solutions have been provided by urban water industries and regulatory agencies, demonstrating that some of these challenges can be addressed. But the institutional and functional organisation of water services is also affected by these changes, which underlines the important governance issues that arise when crises occur and change is needed in urban water management.