To contain the COVID-19 outbreak and mobilize mitigation efforts, public health surveillance relies heavily on individual COVID-19 test results. A shortage of supplies, equipment, facilities, public health professionals, and trained laboratory personnel creates challenges for detection and management of the outbreak, especially in rural and underserved communities. Clinical testing might not be feasible or cost-effective for monitoring the community spread of COVID-19, especially in rural areas. Robust surveillance approaches with a greater coverage potential are needed for developing effective public health strategies during the current pandemic. Findings from recent studies show that the SARS-CoV-2 virus can be detected in stool samples collected from hospitalized individuals, which has led to a new surveillance approach for testing sewage to detect the presence of SARS-CoV-2 RNA. This approach offers a tremendous potential for real-time screening of community spread of COVID-19. This month’s cover highlights a guest commentary, “Sewage Monitoring in Rural Communities: A Powerful Strategy for COVID-19 Surveillance,” that explores the merit, limitations, and challenges of implementing sewage monitoring methods in rural parts of the U.S. to protect public health and inform policy and decision making.