Water quality is one of the most serious problems of environment and national sustainable development strategy now facing China. After hard work over the last several decades, urban-sewage treatment in China is now relatively well developed. It now affords mainly higher levels of sewage collection and treatment, as well as pollution-load control. The characteristic rapid urbanization now occurring in China is still increasing and developing dramatically, and involves large numbers of people. However, in towns, sewage treatment infrastructure is inadequate, and a high percentage of the sewage generated there is not effectively collected and treated. The sewage and pollution load of such towns have become the most important reason for environmental water problems in China. To understand the priorities of sewage treatment in such towns, and their spatial distribution in China, we conducted two nationwide investigations of water use and sewage discharge in towns. Based on the integrated analytic hierarchy process (AHP), assessment indices and a framework of town-sewage treatment priorities in China were constructed. Then, we assessed and analyzed the priorities of towns regarding three aspects of sewage treatment: environmental stress, economic capability, and infrastructure. The results showed that the southeast coastal areas and north China had higher demand for sewage treatment than other areas. The demand in eastern and western areas had obvious differences in spatial distribution, but had nearly no differences within those areas. The towns having the greatest demand for high-priority sewage treatment were concentrated in regions with high economic capability and intense water resource utilization.