This paper is addressed to the problems of infrastructure planning in small and medium towns in India. The paper is based on experiences, case studies, reported by primary researchers including the author. The paper is focussed mainly on the processes of decision making and organization, through special programmes, and regular ones. Among the salients, the low level of investment and quality of urban infrastructure, the centralized decision making systems, the rigidly normative aspects of plans/programmes, the disabling of the local governments in securing the mechanisms of response to community needs, the historicmorphological problems, and the pressures of population density on the natural and human ecological conditions are discussed. The paper concludes with a proposition on the possible strategies in securing a process of decentralization in favour of the local government.