Much of America’s aging drinking water infrastructure is in a state of disrepair that threatens our water quality and public health. If the goal of equitable access to safe water is to be realized, we must rise to the challenge of replacing or upgrading this infrastructure starting in communities that can least afford to do so. This chapter examines the disparate financial burdens, potential health impacts, and environmental justice implications that water infrastructure inequality poses through the problem of lead in drinking water and opportunistic premise plumbing pathogens. The lead-in-water crisis and Legionella outbreak in Flint, Michigan, provides a clarion call to address funding needs, strengthen regulations, incentivize regulatory compliance, promote meaningful public participation, ensure government accountability, and improve public health outcomes.