Issues surrounding water infrastructure, access, and quality are well documented in the Central Appalachian region of the United States. Even in cases where residents have in-home piped point-of-use (POU) water, some rely on alternative drinking water sources for daily needs—including water collection from roadside springs. This effort aims to better understand and document spring usage in this region by identifying the factors that influence drinking water source selection and comparing household and spring water quality to Safe Drinking Water Act (SDWA) health-based and aesthetic contaminant recommendations. Households were recruited from communities surrounding known springs in three states (Kentucky, Virginia, and West Virginia). First- and second-draw, in-home POU tap water samples were collected from participating households and compared to samples collected from local springs on the same day. Samples were analyzed for fecal indicator bacteria and inorganic ions. Study participants completed surveys to document perceptions of household drinking water and typical usage. The majority of survey participants (82.6%) did not trust their home tap water due to aesthetic issues. Water quality results suggested that fecal indicator bacteria were more common in spring water, while several metallic ions were recovered in higher concentrations from household samples. These observations highlight that health risks and perceptions may be different between sources.