This report summarizes the challenges Iowa is faced with in meeting the wastewater treatment needs of its residents, and explores the opportunities for providing ecologically responsible wastewater services for those with inadequate or nonexistent treatment systems. In Iowa, small- (single-home) and mid-size (those serving a few homes or a commercial development) communities offer the greatest opportunity for improvement. This is mainly due to the fact that Iowa has already provided sewer service to large populations where the conventional big pipe approach has been cost-effective. Many of the wastewater treatment technologies available for single-family homes and mid-size populations offer unique environmental benefits such as water reuse and/or zero-discharge to surface waters. Additionally, small treatment systems can provide higher-quality effluents than conventional large-scale treatment works, reducing the adverse environmental effects caused by excessive release of nutrients and pathogenic organisms.