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Abstract The USEPA (United States Environmental Protection Agency) Lead and Copper Rule Revisions allow the use of distributed treatment approaches such as point‐of‐use (POU) and point‐of‐entry (POE) treatment for systems with 10,000 connections or less as a compliance strategy. However, this poses an opportunity for the USEPA to reevaluate system size recommendations for distributed treatment. The current research uses online surveys and semi‐structured interviews (SSIs) to highlight the general sentiment of state regulators managing POU/POE devices and inquiries. Analysis of the 43 survey responses and 13 SSIs revealed that most state regulators described systems of approximately 30–50 connections as the most successful. Resident cooperation, operation and maintenance, monitoring, and the actual implementation of distributed treatment approaches were repeatedly listed as the greatest concerns. As the use of distributed treatment continues to expand, the water sector must devote research efforts to quantitatively determining the drivers of success as well as highlighting clear indicators of potential failure.