Over the past 2 decades there has been a range of reforms to the structure of the water supply and wastewater industries around the world. As yet these reforms have not been as extensive, or as uniform, as in other utilities such as telecommunications, gas, and electricity supply. One focus of reform has been to enhance the structure of water supply and wastewater industries to improve levels of productivity and efficiency while at the same time maintaining environmental and water quality standards, providing affordable access to clean water and encouraging innovation and improvement in service delivery. Now, however, a changing climate, new technologies, and greater emphasis on environmental impacts of supply from traditional sources are creating forces which are requiring a rethinking of traditional water and wastewater industry structures. The purpose of this paper is to examine emerging issues that confront the structure of the water and wastewater industries and to assess them in light of the findings of productivity and efficiency analysis undertaken to date. In doing so, this paper considers how industry structure may impact upon, and be influenced by, the dual achievement of both economic efficiency and issues such as water quality standards, environmental outcomes, innovation, and social goals in an evolving industry environment.