Communities in the United States are being threatened by sewage overflows, flooding, polluted stormwater, leaky pipes, and at-risk water supplies. These threats are a result of the nation’s outdated water infrastructure and water management strategies, and their impacts fall disproportionately on low-wealth neighborhoods and communities of color that are already suffering from a lack of investment and opportunity. Based on the outcomes of an October, 2015 meeting of mayors, municipal leaders and urban water managers, a report by American Rivers was designed to explain the concept of integrated water management; illustrate why cities should consider pursuing its implementation and how cities can lead the way toward solving water challenges across their shared watersheds. The report also provides practical guidance about how city leaders can initiate this important work where they reside. It encourages the pursuit of integrated water management as a pathway to addressing urban water challenges within and beyond city limits.