The use of alternative project delivery methods, such as design-build (DB) and construction manager-at-risk (CMAR) in the design and construction of water and wastewater projects has been hindered by several impediments existing for owner organizations. This study identified these impediments as well as possible solutions when using these delivery methods. A questionnaire was designed and sent to utility managers and wastewater owners of the Water Environment Federation and the American Water Works Association, and 104 responses were received. The results showed that the majority of respondents-representing 32 states in North America-faced such internal impediments as "unfamiliarity with the process" and "resistance to change within management or policy officials" when these delivery methods were used. In addition, most respondents faced external impediments, such as "state procurement statutory requirements" and "municipal or agency procurement regulations." Recommendations based on this study include educating and training the decision makers (policy officials, project staff, and procurement and legal staff) regarding these delivery methods and changing the state procurement rules.