We present a new ground-based visual transmission spectrum of the hot Jupiter WASP-43b, obtained as part of the ACCESS Survey. The spectrum was derived from four transits observed between 2015 and 2018, with combined wavelength coverage between 5,300 Å-9,000 Å and an average photometric precision of 708 ppm in 230 Å bins. We perform an atmospheric retrieval of our transmission spectrum combined with literature HST/WFC3 observations to search for the presence of clouds/hazes as well as Na, K, Hα, and H 2 O planetary absorption and stellar spot contamination over a combined spectral range of 5,318 Å-16,420 Å. We do not detect a statistically significant presence of Na I or K I alkali lines, or Hα in the atmosphere of WASP-43b. We find that the observed transmission spectrum can be best explained by a combination of heterogeneities on the photosphere of the host star and a clear planetary atmosphere with H 2 O. This model yields a log-evidence of 8.26 ± 0.42 higher than a flat (featureless) spectrum. In particular, the observations marginally favor the presence of large, lowcontrast spots over the four ACCESS transit epochs with an average covering fraction f het = 0.27 +0.42 −0.16 , and temperature contrast ∆T = 132 K ± 132 K. Within the planet's atmosphere, we recover a log H 2 O volume mixing ratio of −2.78 +1.38 −1.47 , which is consistent with previous H 2 O abundance determinations for this planet.