We conducted a Health Impact Assessment (HIA) focused on water and sanitation in Vinton, TX, a small rural town on the U.S./Mexico Border. We present the Vinton HIA as a case study to inform the practice of HIA in rural limited resource communities with higher than average levels of unemployment and poverty, and limited infrastructure. Household surveys, focus groups, and interviews provided quantitative and qualitative data on water sources and quality, sanitation practices, and community health. We found that some of the current water sources in Vinton did not meet drinking water standards for total dissolved solids and arsenic; the majority of septic tanks were not managed properly; and there was a short-term risk of water scarcity due to prolonged drought in the region. Prevalent ailments reported by participants included stomach problems, diarrhea, and skin problems.