As the assessment of the economic, environmental, institutional, and social sustainability of wastewater treatment systems may have several conceivable goals and intended recipients, there are numerous different approaches. This paper surveys certain aspects of sustainability assessment that may be of interest to the planners of wastewater treatment systems. Here, the key criteria assess the system’s costs and financing, including its affordability for the users, the environmental impact, the benefits for health and hygiene, the cultural acceptance of the system and its recycled products, the technical functioning, and the administrative, political, and legal framework for its construction and operation. A multi-criteria approach may then be used to analyze possible trade-offs and identify the most suitable system for a certain location.