Urban households in the Dominican Republic face persistent water insecurity due to unreliable access, poor service quality, and widespread informal connections. Most distrust tap water, relying on costly coping strategies like bottled water and home purification. These expenses, along with informality, distort affordability measures and hide unmet demand, disproportionately impacting vulnerable populations. Accurate affordability measures are essential for evaluating welfare changes, sizing market potential, and justifying infrastructure upgrades. Formalizing services and improving quality can unlock scalable, financially viable investments.