Urban water supplies are traditionally based on limited freshwater resources located outside the cities. However, a range of concepts and techniques to exploit alternative water resources has gained ground as water demands begin to exceed the freshwater available to cities. Based on 113 cases and 15 in-depth case studies, solutions used to increase water self-sufficiency in urban areas are analyzed. The main drivers for increased self-sufficiency were identified to be direct and indirect lack of water, constrained infrastructure, high quality water demands and commercial and institutional pressures. Case studies demonstrate increases in self-sufficiency ratios to as much as 80% with contributions from recycled water, seawater desalination and rainwater collection. The introduction of alternative water resources raises several challenges: energy requirements vary by more than a factor of ten amongst the alternative techniques, wastewater reclamation can lead to the appearance of trace contaminants in drinking water, and changes to the drinking water system can meet tough resistance from the public. Public water-supply managers aim to achieve a high level of reliability and stability. We conclude that despite the challenges, self-sufficiency concepts in combination with conventional water resources are already helping to reach this goal.