Constructed wetlands that mimic natural marshes have been used as low-cost alternatives to conventional secondary or tertiary wastewater treatment in the U.S. for at least 30 years. However, the general level of understanding of internal treatment processes and their relation to vegetation and habitat quality has not grown in proportion to the popularity of these systems. We have studied internal processes in surface-flow constructed wastewater-treatment wetlands throughout the southwestern U.S. since 1990. At any given time, the water quality, hydraulics, water temperature, soil chemistry, available oxygen, microbial communities, macroinvertebrates, and vegetation each greatly affect the treatment capabilities of the wetland. Inside the wetland, each of these components plays a functional role and the treatment outcome depends upon how the various components interact. Vegetation plays a uniquely important role in water treatment due to the large number of functions it supports, particularly with regard to nitrogen transformations. However, it has been our experience that vegetation management is critical for achieving and sustaining optimal treatment function. Effective water treatment function and good wildlife quality within a surface-flow constructed wetland depend upon the health and sustainability of the vegetation. We suggest that an effective tool to manage and sustain healthy vegetation is the use of hummocks, which are shallow emergent plant beds within the wetland, positioned perpendicular to the water flow path and surrounded by water sufficiently deep to limit further emergent vegetation expansion. In this paper, we describe the use of a hummock configuration, in conjunction with seasonal water level fluctuations, to manage the vegetation and maintain the treatment function of wastewater-treatment wetlands on a sustainable basis.