Inadequate wastewater and fecal sludge treatment, disposal, and end use systems are arguably the greatest obstacles to achieving sustainable urban sanitation in unserved regions. Strategies for planning and implementing urban sanitation are continually evolving. Demand-driven sanitation with household and community participation is broadly thought to be the way forward. We are skeptical that more time and resources spent garnering household and community demand for sanitation will amount to the much-needed improvements in the treatment and end use components of sanitation systems. We propose shifting the incentives for sanitation from “front-end users” to “back-end users,” thereby leveraging demand for the products of sanitation (e.g., treated wastewater, fertilizer, alternative fuel) to motivate robust operation and maintenance of complete sanitation systems. Leveraging the resource value of wastewater and fecal sludge demands a reuse-oriented planning approach to sanitation, an example of which is the Design for Service approach presented in this commentary.