Historic concepts of sanitation and public health in North America and Europe have informed the creation of sewage treatment systems that use large amounts of treated water to process waste. These systems deplete precious water resources, require large-scale infrastructure investments and onerous maintenance, and disrupt the nitrogen cycle. The author’s experience with sanitation challenges in the Global South has reinforced the value of waterless and low-water sanitation technologies that are suitable for scaling around the world. Two important technologies—compost toilets and vermifiltration systems—are discussed based on their relevance to users in the Global South. The success of new household- or community-level sanitation systems depends on local buy-in, empowerment of diverse stakeholders to participate in the construction and promotion of the technology, and sustained engagement with communities. Such technology increases the quality of life for people living in poverty and combats widespread public health challenges at low cost. It also has neutral or positive impacts on the surrounding environment, particularly water resources.