Under certain conditions, sanitary sewer overflows (SSOs) containing raw wastewater may be discharged to public land and can contribute to environmental and public health issues. Although this problem has attracted the attention of local, state, and federal government and regulators, relatively little SSO abatement research has been published. This study used fixed-media bioreactors, a proven onsite technology in rural areas, to treat wet weather SSO wastewater and reduce its effects on the receiving water environment. The results of this 32-month laboratory study showed that fixed-media bioreactors, especially sand bioreactors, efficiently removed organic matter, solids, and nutrients during six-hour simulated SSO peak flows. Five-day biochemical oxygen demand (BODs) of the simulated SSO varied between 40 and 125 mg/L. The average effluent concentration of BOD5 was 13 mg/L in sand bioreactors at a hydraulic loading rate of 20.4 cm/h. In addition to having high hydraulic loadings, SSO events occur infrequently. This irregularity requires that treatment systems quickly start up and effectively treat wastewater after a period of no flow. This research found that an interval up to six months between two SSO peak flows did not affect the bioreactor performance. Based on this work, fixed-media bioreactors have the potential to reduce the effects of SSOs on the water environment by following proper design parameters and operation strategies. The pollution loading of approximately 18 g BODs/m2 x h is recommended for the efficient performance of sand bioreactors in the SSO treatment.