© 2019 Elsevier Ltd The delivery of water services to the poor is lagging, yet local causes and manifestations of this are not well understood. Better data is needed to identify inequalities where they occur, explore underlying reasons, and develop strategies to achieve more equitable access. A focus on the local scale is important because this is where water services are delivered, and inequalities in access can be best observed. This paper presents a mixed-methods study of poor households’ access to piped water in rural Viet Nam, providing insight into local dynamics of the water/poverty nexus. Findings pointed to lower rates of piped water access for poor households across areas served by government, private and community service providers. Connection fees were found to be the primary barrier to poor households accessing available piped services. The study also found that where financial support is provided, poor households can achieve comparable or even higher rates of access. Key implications of the study are the demonstrated value of, and yet challenges associated with, rigorous local-level monitoring to ensure equitable, quality service delivery.