Background Effective and safe COVID 19 vaccines have been approved for emergency use since the end of 2020 and countries are actively vaccinating their people. Nevertheless, hesitancy towards the vaccines exist globally. Objectives We conducted this study to understand the attitudes towards COVID 19 vaccines and hesitancy to accept it among urban and rural communities in Tamil Nadu, India. Methods We conducted a community based cross sectional study in urban and rural communities among 564 persons who had not been vaccinated yet, selected through multistage random sampling. The vaccine attitude scale (VAX) was used to measure attitudes towards the vaccines and their acceptance of the vaccine was captured by responses to a direct question. Results More than 50% of the respondents had positive attitudes towards the COVID 19 vaccines. Based on their attitudes, they were segmented into four clusters, first with preference for natural immunity compared to vaccines and low concern regarding adverse effects. Second with high level of trust in vaccines and low mistrust. The third cluster members had high level of concern regarding the adverse effects and low levels of mistrust in vaccines and the fourth had high trust in vaccines and low preference for natural immunity. Older individuals with higher education and occupation were more likely to belong to cluster four with high trust in the vaccines. Younger individuals, women, rural residents, belonging to low income labourer class were highly mistrusting of the vaccines. The prevalence of vaccine hesitancy was 40.7% (95% CI – 36.67 - 44.73%), while 19.5% (95% CI = 16.23 - 22.77%) of the respondents were vaccine deniers. While vaccine acceptance was greatest in cluster 1, it was least in cluster 3. Conclusions Vaccine hesitancy was high in urban and rural Tamil Nadu. The population could be effectively segmented into groups based on their attitudes and this understanding can be used to develop targeted behaviour change communication campaigns.