The present study aimed to develop and assess a vulnerability index for access to rural drinking water and sanitation services, which was applied to 42 Rural Sanitation Services in the Coquimbo Region, Chile. For the development and assessment of the vulnerability index, the construction of composite indicator methodology was employed. An underlying model based on 65 indicators, linked to nine sub-pillars and three pillars, was established. In addition, the COINTool software was used for the development and analysis of the composite indicator results. The vulnerability index results showed medium vulnerability at regional and provincial levels, with a greater degree of vulnerability at a commune level. At a Rural Sanitation Services level, 2.4% of the evaluated services presented high vulnerability, 73.8% presented medium vulnerability, and 23.8% presented low vulnerability. The vulnerability index values obtained for the Rural Sanitation Services fluctuated from a minimum value of 32.3% to a maximum value of 64.1%. The significance of the vulnerability indicator developed and assessed lies in its high potential as a tool and/or methodology to monitoring, from a multidimensional perspective, the effectiveness of policies, strategies, and/or actions implemented at the level of Rural Sanitation Services, contributing to strengthened decision-making in vulnerability reduction.