The crisis of inadequate water and sanitation services is particularly pronounced in small cities and towns in the global South. Often constrained by a lack of resources –be they human, technical or economic– these localities are often limited in their capacity to implement programs that are better adapted to the realities of cities. Thus, in place of integrated networks offering universal services, these towns tend to depend on hybrid approaches reliant on the work of NGOs and community groups. To better respond to the particular challenges of small cities and towns, the Colombian government has promoted the creation of regional water corporations whose ownership is shared between a group of adjacent municipalities, served by the utility, and one of Colombia’s major utility service providers whose expertise and leadership are meant to ensure project success. This paper offers an analysis of this model, focusing on the example of Regional de Occidente, a regional water corporation serving four municipalities in western Antioquia. The study examines the degree to which such regional utility corporations respond to the specific needs of small cities and towns. We find that while the approach meets administrative and technical expectations, it suffers from a lack of local government and user support, and remains dependent on community run services in the most deprived areas.