Conventional treatment of water for human consumption and treatment of wastewater for protection of the receiving water bodies and the environment has been credited with being the most important contribution to public health in the last 100 years. While this is undoubtedly true, many of the processes and final disposal of used water have been in need of changes in order to improve efficiency and cost. The disposal of treated water usually at a great cost, and their discharge back to the water courses and the environment has been determined to be less than cost effective. In addition, the discharging of methane from digesters, or the burning of the methane gas has proven to be wasteful and contributes to the proliferation of greenhouse gases. The building of large facilities to treat waste from very large communities of thousands or even millions of people is becoming more difficult as financing is costly and difficult to obtain. New initiatives to address these issues include water reuse from wastewater facilities, and energy recovery to make facilities energy neutral or even energy positive. Recovery of nutrients such as phosphorus and nitrates are also objectives that add to efficiency. This paper focuses on new initiatives in facilities design that are modular, and which can be built to serve small groups or communities, complimented by investigating new treatment technologies, in order to enhance benefits from these more compact treatment units and facilities.