Limited information is available describing point-of-use (POU) water quality in rural Guatemala. Source water quality in eastern Guatemala is of concern given underlying volcanic geology that can leach arsenic and the presence of large-scale mining, which can potentially exacerbate exposure. On-premise piped POU water in the rural community of San Rafael las Flores was sampled in 31 households to characterize a suite of metallic ions and E. coli, along with a survey of water uses and perceptions. Samples were analyzed via standard laboratory methods in the United States and an arsenic quick kit in the field. Fourteen household samples contained arsenic >9 μg/L and 13% of households exceeded at least one Guatemalan and US health-based water quality standard. Survey results revealed widespread dissatisfaction with water quality and service: most participants did not drink their POU water, fearing illness, and instead purchased bottled water or collected from untreated springs. Ideally, establishment of baseline water quality and an understanding of local concerns will facilitate collaborative partnerships and interventions that build community trust in appropriate water infrastructure while identifying surrounding land use impacts. This work represents the first Guatemalan study that quantifies POU contamination while concurrently examining user perceptions, preferences, and concerns.