To investigate why people live in areas at high risk of floods, a qualitative case study was carried out in the areas around Akuressa, in southwest Sri Lanka. Data collection consisted mainly of semistructured interviews with local residents and government officials. The purpose was to study why people live in areas at high risk of floods, by looking beyond the purely physical aspects of living with hazards and exploring the underlying social factors. Four main factors were identified: an overall good living situation; a sense of place; difficulties relocating; and being well-adapted to the situation. The analysis also examined whether government officials shared the views of local residents. The findings highlighted both areas of consensus and discrepancies related to risk awareness, and the efficiency of risk reduction measures that had been implemented by the government. The case study identified and explored underlying social factors, such as risk normalization, risk trade-offs, and push-and-pull processes, which seem to influence the decision to live in a high-risk area.