The urban population is expected to rise up to 68% by 2050, adding 2.5 billion people to the urban areas of the world. The majority of the rise is expected to be in the low-income countries of Asia and Africa. Several cities/towns in the Hindu Kush Himalaya (HKH) region are expanding at a rapid pace, adding additional pressure on water services and basic amenities for urban dwellers. Selected case studies undertaken by the authors suggest that the demand for water far exceeds municipal supply. Water governance in the HKH region remains a blind spot and challenges pertaining to urban water resilience are poorly understood. The paper is divided into three parts: the first outlines the development of towns and their water infrastructure through selected cases in the HKH, followed by key issues and challenges faced by urban systems and suggested measures to build urban resilience in order to deal with the projected rise in population, governance issues and anticipated changes in climate.