As a solution to the shortcomings of centralized systems, over the last two decades large numbers of decentralized wastewater treatment plants of different technology types have been installed all over the world. This paper aims at deriving lessons learned from existing decentralized wastewater treatment plants that are relevant for smaller towns (and peri-urban areas) as well as rural communities in developing countries, such as India. Only full-scale implemented decentralized wastewater treatment systems are reviewed in terms of performance, land area requirement, capital cost, and operation and maintenance costs. The results are presented in tables comparing different technology types with respect to those parameters.