Onsite wastewater systems (OWS) have historically been relied on to treat conventional pollutants and pathogens in a fashion similar to that expected from centralized wastewater systems. However, based on the occurrence of, and potential effects from, contaminants of emerging concern in wastewaters, OWS as well as centralized systems need to account for these compounds in system design and use. One group of contaminants involves organic compounds such as those associated with consumer product chemicals and pharmaceuticals, which are collectively referred to as trace organic compounds (TOrCs) due to their very low levels (e.g., ng/L to ug/L) relative to other pollutants. The question being confronted today is how best to account for TOrCs in onsite system design and use while also achieving other goals such as system simplicity, limited operation and maintenance requirements, low cost, and sustainability. In contrast to conventional pollutants such as nutrients and pathogens which have specific and achievable treatment goals, there are currently no enforceable treatment standards for TOrCs, which often have non-traditional toxicological endpoints (i.e. endocrine disruption). As highlighted in this paper, there are a large number of TOrCs that can be present in OWS and they have different properties, can be present at different frequencies of occurrence and concentrations, and have different susceptibilities to treatment in OWS. In general, based on the studies summarized in this paper, TOrCs normally should not require additional considerations beyond those for conventional pollutants and pathogens (e.g., nitrogen or bacteria and virus) during design and use of OWS. That said, there are situations where TOrCs could be a serious concern warranting special consideration in system design and use. In this paper, the frequency of occurrence of TOrCs and the range of concentrations encountered are highlighted. An evolving approach is outlined that could help assess the likelihood of occurrence and levels of TOrCs along with the treatment anticipated in different OWS and assimilation conditions.