 This study examined the role of local communities in the retention of health workers in rural Tanzania. It found that local communities can either accept or reject incoming health workers depending on their perceptions of the health workers. When communities accept incoming health workers, they provide a warm welcome, help resolve any issues faced by the health workers and link them to the local community. However, when communities reject incoming health workers, they do so by expressing lack of trust, labelling them as foreigners, performing cultural rituals that the health workers fear and discriminating against them due to cultural differences. These findings suggest that fostering good relationships between local communities and health workers is just as important as incentives and other health system strategies for the retention of health workers in rural areas. This article was authored by Nathaniel Cyrili, Daudi Simba, Joseph M. Zulu and others.