Today, there is an urgent need to upgrade existing drinking water and wastewater treatment facilities and build new ones. Aging infrastructure, population growth, and more stringent environmental regulations have been some of the main drivers. Water industry leaders and decision-makers are looking at innovative technological and project delivery solutions to help ease their financial burden. Water and wastewater treatment plants have traditionally been constructed, retrofitted, and rehabilitated using the design-bid-build (DBB) project delivery. DBB has been used for decades and is adequate for projects where the work is well defined and there is relatively low uncertainty (i.e., projects that are repetitive, with low complexity). However, DBB might not be the best method to use for more complex facilities where integration between the different stakeholders can result in more innovation and improve efficiencies. Several organizations have promoted the use of non-traditional, alternative project delivery methods (APDM) such as design-build (DB) and construction manager at risk (CMAR) touting benefits including lower cost, faster schedules, and higher quality. These alternative methods have been used in the transportation and building sectors, and are starting to be adopted in the water utility sector. This paper overviews published sources that have quantified the impact of delivery systems on project performance in several industries. This overview will be the foundation for a discussion of challenges and opportunities of adopting alternative delivery methods in the water and wastewater industry.