In the U. S. about 20% of the population is decentralized from wastewater treatment and disposal. The majority of decentralized populations (65%) are located in rural areas where most households rely on the use of conventional onsite treatment such as septic systems for the disposal of their wastewater. Alternative wastewater treatment systems, such as constructed wetlands (CWs) aim to replace conventional systems by offering improved options for onsite wastewater treatment. This includes water reuse which is mainly practiced at centralized communities; however, with population growth and climate change both threatening to reduce water quantity and quality, saving water of highest quality for potable needs should be encouraged and reclaimed wastewater could plug the gap in water demand. Water reuse projects often face barriers related to a negative public perception but these could be mitigated by including impacted stake holders at the early stages of project design and implementation through community participation and education strategies. This report provides a review of wastewater treatment and reuse with CWs and a case study on the state of CWs as a water reuse and wastewater management tool in North Carolina. An assessment of community perception from 5 decentralized, resource-poor communities in North Carolina using a qualitative research tool and key informant interviews is presented. The results from this project demonstrate CWs as an emerging approach in the decentralized wastewater sector of North Carolina. Perception towards acceptance of water reuse is varied within and across the communities interviewed and dependent on the following factors: trust in water officials, water availability, cost, economic gain and proposed endpoint use of reclaimed water. Nevertheless, community representatives tended to perceive CWs somewhat positively in terms of their attractive features for community wastewater management and reuse capabilities. It becomes clear, however, that CWs can only evolve as a viable alternative to onsite treatment with a program of education and outreach.