Communication partners are instrumental in the successful use and implementation of augmentative and alternative communication systems (AAC), especially in schools, but stakeholder views from low- and middle-income countries (LMICs) are not well represented in the literature. Focus group interviews with seven professionals and three caregivers from South Africa were conducted to understand their perceptions and experiences of AAC use and implementation. The results highlighted additional issues which practitioners in LMICs need to consider when implementing AAC in under-resourced schools for learners with special education needs. Although some challenges overlap with those experienced in high-income countries, such as support and training, high staff turnover and burnout, large caseloads and language and codeswitching differences, these challenges present differently in low-income contexts, requiring alternative solutions. High-income countries do not often need to consider the risk a high-tech AAC device places on the child and their family due to the risk of crime in low-income contexts, the device affordability, the device features and the range of accents available when introducing an AAC system. This exploratory study suggests that LMICs, like South Africa, could make great strides towards providing appropriate AAC technology for all if i) strategic partnerships between governmental and non-governmental groups were put in place, ii) appropriate communication, training and support systems were established, and iii) evidence-based core-language AAC systems were created.