Regulated trace metals and radiological contaminants can participate in a variety of reaction and transport mechanisms that contribute to their nonconservative behavior in drinking water distribution systems. As a result, toxic contaminants such as arsenic, lead, and radium have been measured in customer tap water at levels that are orders of magnitude greater than their levels at system entry points. A recently completed investigation of contaminant occurrence in distribution system deposits provided insight into accumulation trends and highlighted the complexity of the issue. However, the industry—s understanding of inorganics accumulation and release phenomena and associated exposure risks remains limited because of significant research voids. Furthermore, utilities generally are unaware of the scope of the issue and the potential consequences of routine system operations on contaminant occurrence and mobility. This article addresses these issues through a critical distillation of previous investigations, suggested strategies for future research direction, and practical considerations for water utilities.