There is a serious shortage of psychiatrists and poor recruitment of new psychiatry trainees worldwide. Low and middle income countries suffer disproportionately on many accounts. A negative attitude towards psychiatry is thought to contribute to poor recruitment of psychiatry trainees. Previous reviews have focused on the attitudes of medical students in high income countries, but factors relevant to attitude and recruitment may be different in lower income countries. Here we review studies of medical students' attitudes towards psychiatry from low and lower-middle income countries, summarize key themes which negatively influence attitudes, and suggest strategies for overcoming them. Major themes include stigma, perceived status of psychiatry, lack of psychiatric trainers, local cultural beliefs, poor working conditions, and quality of patient care.