The present paper intends to summarize the recent findings regarding the development of alternative treatment methods applicable to small municipal drinking water systems. Small systems are frequently affected by the new permissible arsenic concentration rules, as imposed by several international organizations-World Health Organization, European Commission, United States Environmental Protection Agency. The innovate treatment methods reviewed are (a) adsorptive filtration, using iron oxide coated sand or polymeric materials; (b) zero-valent iron; (c) solar disinfection, solar oxidation and removal of arsenic (SORAS); (d) iron-based adsorbents, such as granular ferric hydroxide (GFH); (e) biological oxidation and removal of arsenic, accomplished simultaneously with the biological iron oxidation. In addition, other more conventional methods for arsenic removal are also discussed, such as iron or alum coagulation, lime softening, ion exchange, activated alumina and membrane separation processes. The aforementioned methods have been comparatively evaluated and the relevant conclusions have been drawn with respect to the applicability of arsenic treatment methods, depending on certain parameters, such as locally varying water quality characteristics, sustainability, and economic feasibility.