The needs associated with the deteriorating water infrastructure are immense and have been estimated at more than $1 trillion over the next 20 years for water and wastewater utilities. To meet this growing need, utilities require the use of innovative technologies and procedures for managing their systems. The U.S. Environmental Protection Agency (EPA) developed an innovative technology demonstration program to meet this need. The purpose of the demonstration program is to evaluate rehabilitation technologies that have the potential to reduce costs and increase the effectiveness of the operation, maintenance, and renewal of aging and deteriorating water distribution and wastewater conveyance systems. This paper provides an impartial assessment of the effectiveness and cost of four innovative technologies for water distribution and wastewater collection pipes. The technologies demonstrated include spray-on polymeric lining and cured-in-place pipe (CIPP) lining for water mains; and spray applied geopolymer mortar and an internal pipe sealing system for wastewater mains.