When setting water quality standards (WQS) for surface water, every state in the nation is faced with the question of “how clean is clean enough?” The standard set by the state is important to citizens, who rely upon a high level of water quality, as well as municipal and industrial wastewater dischargers who must comply with permit limits that take WQS into account. An issue receiving increasing attention is the health risk to persons who eat relatively large amounts of fish and shellfish that may be contaminated with toxic substances. Three states in the Pacific Northwest—Idaho, Oregon, and Washington—are leading the way in considering whether to base their WQS on higher rates of fish consumption, resulting in more stringent standards. On September 16, 2014, the Environmental Law Institute convened an expert panel to answer questions such as: What are the key issues in setting WQS? How does a state calculate the amount of fish its citizens eat? What are the relative roles of EPA, states, the public, and industry in ensuring that state WQS are protective of all populations? What will happen to industry discharge permits as a result of new WQS? In this Dialogue, we present a transcript of the event, which has been edited for style, clarity, and space considerations.