Safe drinking water remains a major global challenge, especially in rural areas where, according to UNICEF, 80% of those without access to improved water systems reside. While water, sanitation, and hygiene (WASH)-related diseases and deaths are common outcomes of unsafe water, there is also an economic burden associated with unsafe water. These burdens are most prominent in rural areas in less-developed nations. Slow sand filters (SSFs), or biological sand filters (BSFs), are ideal water treatment solutions for these low-resource regions. SSFs are the oldest municipal drinking water treatment systems and improve water quality by removing suspended particles, dissolved organic chemicals, and other contaminants, effectively reducing turbidity and associated taste and odor problems. The removal of turbidity and dissolved organic compounds from the water enables the use of low-cost disinfection methods, such as chlorination. While the working principles of slow sand filtration have remained the same for over two centuries, the design, sizes, and application of slow sand filters have been customized over the years. This paper reviews these adaptations and recent reports on performance regarding contaminant removal. We specifically address the removal of turbidity and microbial contaminants, which are of great concern to rural populations in developing countries.