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This article argues that in order to equitably address real public health issues facing communities of all sizes, affordability must be clearly understood and addressed. After seven years of experience with the current drinking water affordability criteria, the U.S. Environmental Protection Agency (USEPA) concluded in 2006 that refinements should be considered to address the situations within communities with below-average incomes or above-average costs (USEPA, 2006). The article discusses affordability and exemptions, affordability and variances, affordability criteria under review, and achieving sustainable water systems. Includes 11 references.