The removal of phosphorus (P) from domestic wastewater is primarily to reduce the potential for eutrophication in receiving waters, and is mandated and common in many countries. However, most P-removal technologies have been developed for use at larger wastewater treatment plants that have economies-of-scale, rigorous monitoring, and in-house operating expertise. Smaller treatment plants often do not have these luxuries, which is problematic because there is concern that P releases from small treatment systems may have greater environmental impact than previously believed. Here P-removal technologies are reviewed with the goal of determining which treatment options are amenable to small-scale applications. Significant progress has been made in developing some technologies for small-scale application, namely sorptive media. However, as this review shows, there is a shortage of treatment technologies for P-removal at smaller scales, particularly sustainable and reliable options that demand minimal operating and maintenance expertise or are suited to northern latitudes. In view of emerging regulatory pressure, investment should be made in developing new or adapting existing P-removal technologies, specifically for implementation at small-scale treatment works.