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Slow sand filters (SSF) are a simple water treatment technology providing an important alternative to conventional drinking water treatment. SSF are extensive in terms of carbon cost and chemical use but require a large land area and are complex to operate, as periodic cleaning is required to prevent filter clogging. Therefore, redundant SSF beds are required to enable water production to occur during long cleaning downtimes. Underwater skimming (UWS) is a cleaning innovation where the foulant layer (containing sand and particles) is removed using a skimmer consisting of a shrouded blade mounted on a vehicle platform. Sand, particles, and biofilm are skimmed prior to ex situ washing of the recovered sand. In this Viewpoint, we posit that the introduction of an in situ underwater skimmer operated remotely can substantially help to offset the aforementioned challenge of downtime, with its associated loss of production, enabling the technology to operate more efficiently and remain a pertinent and advantageous process option within modern water treatment facilities or possibly resource constrained settings. Otherwise, this resilient biotechnological process could be replaced by chemical and energy-intensive processes which increase the entropy of water treatment more than SSF. The anticipated benefits and challenges of UWS of SSF are discussed.