The variety of tools available to the sewer utility engineer today is remarkably different than it was during the 1960s. However, the average rate of system rehabilitation and upgrading within the U.S. is still not adequate to keep pace with increasing needs, quality demands, and continually deteriorating systems. The objective of this report is to summarize the current status of the development and application of repair, rehabilitation, and replacement technologies for wastewater collection systems. This report covers technologies applicable to sewer mainlines, laterals, manholes, and other appurtenances such as lift stations. The emphasis of the report is on trenchless technologies, which do not require full excavation of the buried asset in order to carry out the work. These technologies have made a significant penetration into the U.S. market with estimates of the proportion of rehabilitation work carried out using trenchless techniques ranging up to 70% in the sewer sector (Carpenter, 2009). There is still considerable room for improvement in existing trenchless technologies and/or in the development of new trenchless technologies. Such improvements or new technologies offer the chance to make the investments in rehabilitation more effective and to extend the ability of utilities and local governments to fix larger portions of their systems with current funding levels. A secondary benefit is to increase the political and public will to spend additional money on fixing this problem.