This paper describes how a large proportion of sub-Saharan Africa’s national (and urban) population lives in urban centres other than large cities and considers what we know about risk in these urban centres. The region has thousands of urban centres with under 20,000 inhabitants and probably over 1000 with between 20,000 and 49,999 inhabitants. These and other relatively small urban centres also have importance for national economies, for local government services and for producer and consumer service provision to their and to their surrounding (usually predominantly rural) populations. The paper suggests that within the region’s urban population, inadequacies in provision for basic services are usually larger, the smaller the urban centre. Indeed, it seems that most small urban centres in the region have local governments with very little capacity or funding to fulfil their responsibilities for risk reducing infrastructure and services. Of these, the inadequacies in provision for water and sanitation are the best documented. But in some instances, provision for water and sanitation is so poor in large cities that the proportion of their inhabitants lacking adequate provision is as high as those living in small urban centres.