The influx of refugees, population growth and current agricultural practices have led to an increase in water demand in Jordan, placing pressure on existing water provision. Climate change further exacerbates declining water availability. Against this backdrop, the techno-economic feasibility of four water supply and sanitation alternatives for small and medium scale cities in Jordan were explored, using local unit costs and Al-Mafraq as a case study. City level piped network combined with household rooftop rainwater harvesting and surface runoff collection into local ponds and piped networks with treatment using the nature-based solution of root-zone for sanitation were demonstrated to provide the highest benefits in terms of cost, convenience and water conservation. Our work highlights the need to invest in long-term urban infrastructure networks to promote sustainable future growth of cities. This is vital to address severe water scarcity challenges that ultimately impact those at the urban fringes most.