Rapid urbanization and alteration in lifestyle occurring across the globe has resulted in an un-controlled generation of municipal solid waste. Various strategies have been tried and tested for obtaining a sustainable result in municipal solid waste management. Nonetheless, in most of the cases, they have created negative health, environment and socio-economic impacts, particularly in developing countries. Furthermore, the attitude of the common people towards the waste they generate, often acts as a barrier for adopting sustainable strategies for its management. Two main approaches are being followed in municipal solid waste management: a centralized and a decentralized approach. There exists an ongoing debate with regard to the efficiency of the two approaches. Taking the Thiruvananthapuram Municipal Corporation in Kerala, India as a case to observe, this paper examines the merits, demerits, and practicability of these two approaches, and tries to suggest a sustainable model to curb the issue of municipal solid waste management in urban settings.