Background . The quality of care, attitudes of staff and long-term recruitment of practitioners have been shown internationally to improve health services as a result of a health facility accepting students for teaching. This study aimed to develop further insight regarding the impact of undergraduate student involvement on district health services in South Africa to understand the issues in a resource-constrained environment. Objectives . To describe the effect of the placement of undergraduate students on service delivery, and to understand the health service and academic factors that influence this effect. Methods . A descriptive study, using qualitative methods, was undertaken in two rural sites where undergraduate health science students had been recently introduced. Potential respondents were identified to be interviewed on the basis of their positions in the health services, their degree of involvement with students and their knowledge of the health system. Results . Sixteen participants were interviewed, and described the effect of undergraduate students on service delivery in terms of a balance between the burden and benefit. Three pivotal issues, which could tip the balance in favour of one or the other, included the length of time of student rotations, seniority of the students and number of students allocated to a particular site. Overall, it would appear that the balance was marginally in favour of the benefit of student service delivery. Conclusion . Undergraduate students can add value to service delivery under certain conditions, but further research is needed to quantify this effect.