Achieving water security in South Asian cities will require a realistic and holistic understanding of the challenges that are growing in extent and severity. These challenges include the rapid rise in urban household water demand due to both overall population growth and increasing urbanization rate. Additionally, surface water supply in closed river basins is fully utilized, and there is little opportunity in these regions to increase the extraction of surface water to meet rising demands. Furthermore, groundwater extraction in most regions exceeds natural recharge rates, leading to rapidly falling annual water tables and seasonal depletion in hard rock regions and to gradually declining water tables requiring deeper wells and increased pumping effort in alluvial regions. Additionally, even in cities with abundant water resources, poorer segments of the population often face economic water scarcity and lack the means to access it. Nevertheless, there are important potential engineering opportunities for achieving water security in South Asian cities. Much withdrawn water is lost due to urban water distribution inefficiency, and a range of proven techniques exist to improve distribution. Metering of urban water can lead to structural improvements of management and billing, though the water needs of the poorest city residents must be ensured. Industrial water-use efficiency can be significantly improved in manufacturing and electricity generation. The quantities of wastewater generated in South Asia are large, thus treating and reusing this water for other purposes is a strong lever in enhancing local water security. There is limited potential for rooftop rainwater harvesting and storage, though capture-enhanced groundwater recharge can be important in some areas. Some individual inter-basin transfer projects may prove worthwhile, but very-large-scale projects are unlikely to contribute practically to urban water security. Overall, the water challenges facing South Asian cities are complex, and although no single intervention can definitively solve growing problems, numerous actions can be taken on many fronts to improve water security.