The Safe Drinking Water Act’s (SDWA) contaminant-by-contaminant regulatory approach increasingly falls short of delivering meaningful opportunity for improved public health risk reduction. While significant progress was made by earlier efforts regulating microbial and the most substantial chemical contaminant concerns, recent efforts offer only marginal improvements at rising cumulative costs. The growing risks of water system failure due to aging infrastructure, workforce shortages, and climate disruptions are not directly addressed by the current regulatory framework. After examining national compliance data, cumulative cost-benefit analyses, and the Relative Health Indicator (RHI) approach developed to compare contaminant risks, three recommended strategic shifts emerge to improve the SDWA regulatory framework and implementation: (1) prioritize the greatest risks using available resources; (2) achieve compliance with current regulations for all water systems, everywhere, all the time; and (3) establish minimum expectations for water system operations and resilience to avoid failures that can incur substantial public health concerns. These strategies are essential to achieve and maintain meaningful public health protection with our limited, available resources balanced against cumulative costs.