Households that cannot be able to afford their water bills may lose access to drinking water and wastewater services. This study seeks to quantify how many households may struggle to pay for water services across 787 of the largest drinking water providers located within each state of the United States. Household water affordability is the ability for a household to pay for basic water services without undue hardship. Here, we select 6,000 gallons per month (22.7 m3/mo) as sufficient to meet basic needs and define undue hardship as spending more than 4.6% of household income (one day of labor each month) to pay for water services. Monthly bills are combined with census income data based on service area boundaries to determine how many households are spending more than 4.6% of their income on water services. We find that basic water services are unaffordable for 17% of the households (28.3 million persons) in this study. The median, or representative community, has one in seven households spending more than 4.6% of their income paying for water services. We developed a data visualization tool to allow users to explore how affordability challenges change across different volumes of water usage and levels of financial hardship (https://nicholasinstitute.duke.edu/water-affordability/water-affordability-united-states). This research shows that household water unaffordability is not a localized problem but rather is a challenge experienced by households in communities across the nation.