The implementation of the EU-water framework directive (EU-WFD) demands a financeable and adaptable sewage treatment, creating a need for action especially in rural areas, where the “good ecological status” is often not reached even though the sewage works fulfill the legal minimum requirements. Therefore the construction of new, more efficient wastewater treatment plants is advisable. Due to the precarious financial situation in most rural areas, many municipalities can however not master the necessary funds for an improved waste water infrastructure. A large part of the costs would have to be shouldered by the local population in the form of additional sewage levies, leading to massive socio-economic strain. Hence, different solutions, which are tailored to the socio-economic, demographic and environmental characteristics of rural areas and fulfill the legal requirements, need to be developed. One possible approach is presented in the form of the Dirlammen case study (municipality Lautertal, Hesse, Germany). It consists of 1) biological and physicochemical analyses of the waste waters, 2) a modified eco-balance for the construction of a new sewage works and 3) socio-economic and demographic analyses of the population. It serves as a tool for the assessment of the influencing ecological, socio-economic and demographic factors on the sewage problems in rural areas. These findings can easily be transferred to other rural areas with a similar configuration and thus deliver the basis for a generally applicable approach to these problems. The results of the comprehensive analysis have shown for the municipality Dirlammen/Lautertal that the continued operation of the existing pond sewage plant is, with regards to the ecological, socio-economic and demographic points of view, preferable to the construction of a new waste water treatment plant. With regard to the sustainability principles of the sewage treatment and the objectives of the EU-WFD, existing sewage works should be operated for as long as the sewage treatment is feasible within technical and legal boundaries. With the construction of new facilities on the other hand, the expected improvement of the water quality has to be weighed against the ecological impairments caused by the construction itself. Rural waste water plans have to be developed for the long-term, taking not only the ecology into account but also the demographic change. Possible approaches in this regard could be a shift towards a decentralized waste water treatment concept and–even more important–improvements of the river morphology. But also the reduction of the diffuse pollution from agricultural sources should be considered for the development of strategies for the improvement of the ecological state. Short-term optimization measures in the existing sewage works might also improve the water quality until the long-term development plans can be implemented. In particular the challenges of the demographic change and linked with that the changing requirements for the rural waste water treatment must be addressed by any future plans. Only with the help of such a comprehensive approach the dangers of bad planning and unacceptable socio-economic burdens can be minimized.