New drinking-water regulations for per- and polyfluoroalkyl substances (PFAS) are forcing utilities operating in interconnected urban “One Water” systems to make strategic choices between short-term compliance measures and more transformative interventions with long-term sustainability benefits. To examine how utilities navigate this trade-off, we worked with practitioners in the Occoquan Reservoir system (USA) to define and evaluate 57 interventions spanning drinking-water treatment, wastewater management and watershed source control. Preferred near-term strategies centered on mature treatment technologies, whereas longer-term options included advanced treatment adoption, source-control measures, regulatory actions, raw-water blending and adaptive treatment operations. The final intervention portfolio distributes action, cost and risk across multiple components of the One Water system, illustrating how regulatory pressure can catalyze sustainable pathways for PFAS management.