Poor South Africans are significantly poorer and have lower employment rates than the subjects of most published research on gambling prevalence and problem gambling. Some existing work suggests relationships between gambling activity (including severity of risk for problem gambling), income, employment status and casino proximity. The objective of the study reported here is to establish the prevalence of gambling, including at risk and pathological gambling, and the profile of gambling activities in two samples of poor South African adults living in a rural and a peri-urban community. A total of 300 (150 male, 150 female) adults in KwaZulu-Natal, South Africa in communities selected using census data, completed the Problem Gambling Severity Index and a survey of socioeconomic and household information, and of gambling knowledge and activity. It was found that gambling was common, and—except for lottery participation—mostly informal or unlicensed. Significant differences between rural and peri-urban populations were found. Peri-urban subjects were slightly less poor, and gambled more and on a different and wider range of activities. Problem and at risk gamblers were disproportionately represented among the more urbanised. Casino proximity appeared largely irrelevant to gambling activity.