840 million people living in rural areas across the world lack access to electricity, creating a large imbalance in the development potential between urban and rural areas. Pico-hydropower offers a cost-effective way of accessing electricity, where the resource exists. This paper discusses and critically examines several challenges that remain in implementing pico-hydropower systems, such as local manufacturing, maintenance and repair of turbines, low-head solutions, dealing with variation in the water flow between seasons, the ability to deal with income generating loads and low system power and capacity factor. The solutions to many of these problems exist; several low head turbine systems are appearing on the market, and new power electronic packages are able to improve the system capacity factor. Some turbines are now being designed for local construction using design for manufacturing rules, so only basic workshop tools and process are required to build turbine systems and components, and enabling turbines to be locally repaired. Through the commercialisation and implementation of these solutions, the proliferation of pico-hydropower systems can take place providing low cost sustainable electricity for remote communities, but this requires a stronger emphasis in social awareness and policy. Three critical enabling factors for the success of pico-hydropower projects are identified through this analysis: understanding the local context, financial sustainability and stakeholder awareness.