A majority of the region’s waters, despite significant improvements in recent decades, are still so polluted they contribute to health risks and are unfit for swimming, fishing, or supporting a biodiverse environment. The main recurrent sources of pollution, stormwater runoff and the discharge of combined stormwater and untreated sewage, will only get worse as climate change brings more frequent and intense storms. The federal government, states, and municipalities should work together to eliminate all combined sewer overflow by 2040. This will require incorporating green infrastructure strategies into building and zoning codes, and strengthening clean-water standards. We can accelerate this process by establishing neighborhood green districts that implement pilot projects, and by imposing a stormwater utility fee to fund and advance new infrastructure initiatives.