Elevated fecal indicator bacteria levels remain the most frequent cause of water quality impairment in streams, rivers, lakes, estuaries, beaches and drinking water supplies across the U.S. Controlling bacteria represents a major challenge for state and local governments that seek to protect public health at the lowest cost for their citizens. This review summarizes what has been learned in the last 10-15 years and presents the latest science in a way that is both accessible and actionable.