There is an urgent need for innovation in the sanitation sector because the conventional model (toilet-to-sewer-to-treatment) is too time-consuming and costly, and alternatives are lacking. We estimate the challenge ahead by developing scenarios for 60 of the fastest-growing urban conglomerates in the World. We find that the majority would need to build out their sewer systems at a rate that is ten to 50 times higher than the highest rate for any project in the World Bank’s database, which is unrealistic. We also carry out a case study of Lagos, Nigeria, which suggests that, in any given year, 14–37% of Lagos State’s budget would need to be invested to provide sanitation to the presently underserviced population while keeping up with population growth, which also is unrealistic. Our study provides clear evidence that the conventional model for sanitation is unworkable for rapidly growing urban areas. We conclude there is an urgent need to encourage and fund projects that promote innovations that can tackle the three core challenges: can be built sufficiently quickly, are flexible, and affordable. This is not likely to happen unless the future generation is systematically trained and educated to creatively support innovation in sustainable sanitation.