By 2050 it is predicted that 67% of the world population is expected to be living in urban areas, with the most rapid levels of urbanisation taking place in developing countries. Urbanisation is often directly linked to the degradation of environmental quality, including quality of water, air and noise. Concurrently, the climate is changing. Together, the negative impacts of climate change and urbanisation pose significant challenges, especially in developing countries where resources to mitigate these impacts are limited. Focusing on the Berg River Catchment in South Africa, which is experiencing increasing levels of urbanisation, the impacts of climate change, the ‘wicked problem’ of service delivery to the historically disadvantaged within a developing country, persistent infrastructure backlogs, and where high unemployment is prevalent, this paper explores the increasing water quality risks due to climate change and rapid urban development and the likely direct and indirect economic impacts that this will have on the agriculture sector, which is a key contributor to the regional and national economy. The results give support to the need to invest in risk mitigation measures including the provision of basic services, the upgrading and maintenance of wastewater treatment plants and investing in ecological infrastructure.