This article explores media preferences of advertisers in Least Developed Countries (LDCs) using the case of Ethiopia. Study 1 demonstrates that billboards are the most popular medium in an LDC. Study 2 builds on these findings and provides an explanation of why billboards are prevalent in an LDC. The most important reasons for using billboards include tangible response, media efficiency, location, visibility, and LDC-specific factors. Study 2 also provides an overview of managers' beliefs regarding billboard effectiveness. According to the managers in an LDC, the factors contributing to billboard effectiveness are clarity, name identification, location of billboard, visuals, readability, information, physical aspects, creativity, and integrated marketing communications. Finally, this article investigates the relationship between the reasons for using billboards and managers' perceptions of what makes them effective. Overall, these studies fill a void in the literature by researching issues that were less explored by earlier studies, particularly in the context of an LDC. Implications for marketing scholars and practitioners are delineated in the article.