This paper provides an overview of the current state of drinking water provision in urban and rural India, and discusses technological, economic, and political areas for reform. The status quo of municipal water provision in urban areas is shown to have resulted in many poor households being excluded from the water network, while even those with a piped connection generally do not receive a regular supply of good quality water. We discuss the scope for pricing reform and actions which could be taken to make this more politically feasible, and describe the preconditions needed for private-sector involvement. In rural and peri-urban areas we make the case for ‘intermediate’ technological options and multi-institutional partnerships. We then outline low- to intermediate-cost options for water delivery, water augmentation and water treatment. In each case, we review the technology, give examples of the capital and operational costs, discuss the challenges to extending access through this means, and cite case studies showing how access was extended to previously underserved populations. We conclude by delineating key institutional and informational concerns which must be addressed in order for India to successfully alleviate its household drinking water deprivation.