Waterborne bacterial, viral and parasitic pathogens are a global health concern and their rapid and specific detection in contaminated potable water is of utmost importance. Biosensors using a variety of biorecognition molecules and transduction methodologies have been reported, and have the potential to enable highly sensitive detection of the analyte of interest in a short time with high specificity. However, there are several obstacles to the detection of waterborne pathogens-they tend to be present at very low concentrations in the environment and environmental samples contain numerous inhibitors of enzymatic reactions and interfering organisms and particulates. Here we present a review of the current state of biosensor technology with regard to the improvements needed over standard detection methods and the challenges presented by real environmental samples. Further, we identify future areas of focus necessary to realize novel detection devices capable of supplanting the gold standards of today.