FLINT, Mich.—Melissa Mays looks around the emergency room at a frail, elderly man in a wheelchair and a woman with a hacking cough and can’t quite believe she’s here. Until a few months ago, she was healthy—an active mother of three boys who found time to go to the gym while holding down a job as a media consultant and doing publicity for bands.

But lately, she’s been feeling sluggish. She’s developed a rash on her leg, and clumps of her hair are falling out. She ended up in the emergency room last week after feeling “like [her] brain exploded,” hearing pops, and experiencing severe pain in one side of her head.

Mays blames her sudden spate of health problems on the water in her hometown of Flint. She says it has a blue tint when it comes out of her faucet, and lab results indicate it has high amounts of copper and lead. Her family hasn’t been drinking the water for some months, but they have been bathing in it, since they have no alternative.

“It set off a train wreck in my system,” Mays told me, sitting in the emergency room. Later, doctors would put her on beta blockers after finding problems in the arteries around her brain.

In the past 16 months, abnormally high levels of E. coli, trihamlomethanes, lead, and copper have been found in the city’s water, which comes from the local river (a dead body and an abandoned car were also found in the same river). Mays and other residents say that the city government endangered their health when it stopped buying water from Detroit last year and instead started selling residents treated water from the Flint River. “I’ve never seen a first-world city have such disregard for human safety,” she told me.

While Flint’s government and its financial struggles certainly have a role to play in the city’s water woes, the city may actually be a canary in the coal mine, signaling more problems to come across the country. “Flint is an extreme case, but nationally, there’s been a lack of investment in water infrastructure,” said Eric Scorsone, an economist at Michigan State University who has followed the case of Flint. “This is a common problem nationally— infrastructure maintenance has not kept up.”

Indeed, water scarcity in the parched West might be getting the most news coverage, but infrastructure delays and climate change are causing big problems for cities in the North and Midwest, too. Last summer, hundreds of thousands of people in Toledo were told not to drink tap water because tests showed abnormally high levels of microcystins, perhaps related to algae blooms in Lake Erie. Microcystins can cause fever, headaches, vomiting, and—in rare cases—seizures. Heavy rainfall has caused backups in the filtering process at overloaded water-treatment plants in Pennsylvania, and so residents are frequently finding themselves under advisories to boil water. And Chicago, which installed lead service lines in many areas in the 1980s, is now facing a spike in lead-contaminated tap water.

In 2013, America received a “D” in the drinking-water category of the American Society for Civil Engineers’ Report Card for America’s Infrastructure. The report found that most of the nation’s drinking-water infrastructure is “nearing the end of its useful life.” Replacing the nation’s pipes would cost more than $1 trillion. The country’s wastewater infrastructure also got a “D” grade.

Hydrant flushing in Flint (Alana Semuels / The Atlantic)

Like many cities in America, Flint has lost residents but still has to provide services like water and sewer and road maintenance within the same boundaries. All while bringing in less tax revenue to pay for it. Flint has not had the money to spend on crucial infrastructure upgrades, and has left old pipes in place for longer than most engineers would recommend. Water prices are rising in Flint, like they are in lots of other cities, but the quality of water is getting worse, not better.

Flint has financially struggled for longer than most American cities. The birthplace of General Motors, the city began having problems in the 1980s and ’90s when GM started closing plants. By 2001, its unemployment rate was 11.2 percent, which grew every year until it reached 25 percent in 2009. Families began to seek opportunity elsewhere, leaving behind empty homes. As the city’s population declined, it struggled to come up with the revenue to provide basic services such as police and fire coverage for residents. The water system, though, was still a “cash cow,” said Scorsone, the professor, so Flint borrowed from the water authority to pay its city bills.

Flint has been buying water from Detroit since 1967. The Detroit Water and Sewer Department, in the booming post-war years, expanded its services, adding 1,000 square miles of territory. But as the population began to shrink in both Detroit and Flint, fewer customers were left to pay for infrastructure and services. Detroit began raising rates, but Flint didn’t pass those rate increases on to customers because residents were struggling economically and politicians worried they’d get voted out of office, said Scorsone. That meant that little to no money was spent on infrastructure upgrades.

In 2004, Detroit charged Flint $11.06 per million cubic foot of water. By 2013, it was charging $19.12 per million cubic foot, a 73 percent increase.

“It’s a combination of bad management and bad economics,” Scorsone said.

Downtown Flint (Carlos Osorio / AP)

By 2011, Flint had a $15 million deficit and Michigan Governor Rick Snyder appointed an emergency manager to take control over the city. It was a move that upset many, since emergency managers are used to replace elected officials such as city councils and mayors and have widespread authority, but less connection to residents. In 2012, Michigan voters repealed an emergency-manager law that had allowed emergency managers to take over troubled cities and school districts. But the state legislature then passed a different, and more far-reaching, emergency-manager law later that year. A group of citizens, including some from Flint, filed a lawsuit arguing that the law violated their constitutional right to equal protection. In November, a judge allowed the suit to go forward.

Unwilling to pay rising Detroit water costs, Genesee County, where Flint is located, decided to work with other Michigan counties to build a pipeline from Lake Huron to mid-Michigan. But the pipeline, called the Karegnondi Water Authority, won’t be completed until late 2016. So in 2013, Flint decided that until the pipeline was finished, it would pump water from the Flint River, treat it, and sell it to residents. The plan would save the city much-needed money: The annual cost to treat water from the Flint River is $2.8 million, said Howard Croft, the city’s public-works director. Buying water from Detroit, on the other hand, costs $12 million a year.

But making river water safe for public use is a much more difficult task than treating reservoir or lake water. Rivers are subject to runoff and the water quality can change quickly with air temperature or heavy storms. Flint found this out as soon as it turned off the pumps from Detroit and started pumping its own water in April 2014.

Residents said they noticed the difference almost immediately. Melissa Mays says her water started smelling like rotten eggs, and had a strange tint when coming out of the faucet, sometimes blue, sometimes yellowish.

Claire McClinton, a GM retiree, said her house began to smell like garbage. Another resident, Bethany Hazard, says her water started coming out of the faucet brown and smelling like a sewer, and when she called the city to complain, she was told the water was fine.

The water was not fine. First, tests showed there was fecal coliform bacteria in the water, and the city had to issue numerous boil advisories to citizens. In response, engineers upped the amount of chlorine in its water, leading to dangerously high levels of trihalomethanes, or TTHMs, which put Flint in violation of the Clean Water Act. TTHMs are especially dangerous when inhaled, making showering in hot water toxic.

By October, GM, which still has a plant in Flint, had started noticing that the water was corroding parts of its engines. The plant switched off the Flint water, and started trucking in water from elsewhere. It asked the city for permission to use water from Flint Township, rather than the city of Flint (Flint Township was still buying water from Detroit), and switched back to Detroit water, said spokesman Tom Wickham.

LeeAnne Walters didn’t notice any changes right away. But a few months after the switch, she noticed that her children were getting rashes between their fingers, on their shins, on the back of their knees. Her four-year-old son, who has a compromised immune system, started breaking out into scaly rashes whenever he swam in their salt-water pool, which he’d used since birth. Then Walters’ 14-year-old son got extremely sick and missed a month of school.

So she sent her water off to Marc Edwards, a Virginia Tech environmental engineering professor who had forced the CDC to admit it had misled the public about the amount of lead in D.C.’s water.

Edwards was shocked when he found that Walters’ lead content was 13,000 parts per billion. The EPA recommends keeping lead content below 15 parts per billion.

“At first I didn’t believe the results because they were the worst I’d ever seen, and I’ve seen a lot,” Edwards told me.

LeeAnne Walters shows a water filter from her home. (Alana Semuels / The Atlantic)

None of the samples Walters sent were safe to drink. Some had lead content of 200 parts per billion. Over 30 samples, the average lead content was 2,000 parts per billion, which meant that no matter how long Walters let her taps run, it still would have been toxic. This could easily have been causing the health problems that Walters and her children were experiencing.

“Lead is the best known neurotoxin, it adversely impacts every system in the human body,” Edwards told me. “Certainly it could have caused children’s lead poisoning.”

The city says it does not know why so much lead was found in Walters’ pipes, but Edwards has a theory: Many cities have lead pipes, and when water sits in those pipes, the lead can leech into the water. So cities usually add corrosion-control chemicals, such as phosphates, to keep the lead out of the water. But because Flint didn’t take such precautions when they began pumping their own water, “the public health protection was gone,” Edwards says.

The water situation has made people furious with the city, and with the emergency-manager system of government. Residents say Flint first learned about the high levels of TTHMs in May 2014, but didn’t inform residents until January. City meetings have devolved into a mob of angry residents yelling at the emergency manager.

“We still don’t have a true democracy,” said Claire McClinton, the retiree. “As soon as [the emergency manager] sets foot in your city, your local government is gone.” In March, Flint’s city council voted to “do all things necessary” to once again purchase water from Detroit, but the city’s emergency manager nixed the vote, calling it “incomprehensible.” The emergency manager stepped down in April, announcing that the city was on firmer financial footing, but one of his last orders was that the city council could not change any of his orders for a year, including the order to switch to Flint water.

Flint last week sent out yet another notice that tap water had higher than acceptable levels of TTHMs. There are currently two lawsuits pending about the water issues, one of which questions the city’s financial accounting, another demands that the city go back to Detroit water because Flint’s water quality is so poor.

Drainage into the Flint River (Alana Semuels / The Atlantic)

Many Flint residents have a visceral reaction to the water problem, and have focused their attention on the emergency manager, on their city’s finances, and on the unfairness of their situation.

“How many times can they kick the people who live here?” Melissa Mays asked me in frustration.

But it’s not one emergency manager, or one bad decision about pumping water from the Flint River that has led these problems—and that might be the scariest part of all. Neglected infrastructure is really to blame, but it’s not quite as satisfying to blame old pipes as it is to blame the people in charge. And the city’s financial woes have a lot to do with its shrinking population, but it’s hard to blame the people who left in hopes of finding employment or a better life elsewhere.

Eroding infrastructure isn’t unique to Flint. Things just broke down there first.

In a report released to its members last month, the American Water Works Association warned that many utilities across the country won’t have the money to perform much-needed infrastructure upgrades over the upcoming decades. Utilities are seeing water sales declining as households and commercial clients become more efficient, but, like Flint, still have to provide the same infrastructure as before with less revenue.

“There is a gap between the financial needs of water and wastewater systems and the means to pay for these services through rates and fees,” the report read.

“They don’t have money to even do the best practices according to our currently lousy best practices,” says Edwards, of Virginia Tech. “They have even less money than normal to address these very, very expensive problems.”

And if utilities can’t pay for much-needed upgrades, other cities might soon find themselves in the same situation as Flint.