This study considers the Old Brahmaputra River, Bangladesh, as a case study regarding community perceptions on urban pollution and its impact on rural communities. In doing so, in-depth individual interviews (n = 195), key informant interviews (n = 7), and focus group discussions (n = 7) were conducted by emphasizing different perspectives on urban pollution and its effects on people related to losses of fisheries resources, agricultural production, human health, and livelihood transformation. The findings illustrate that poor urban solid waste management and direct sewage discharge degrade rivers daily. The most vulnerable rural communities are directly dependent upon the river, including fishermen, farmers, and boatmen. Specific measures such as an effluent treatment plant should be established near the river, and households and commercial drains should be cut off from the direct connection with the river. Alternative income-generating activities for the stakeholders are suggested to safeguard the river from urban pollution and the wellbeing of the stakeholders. View Full-Text