Background: Hearing loss affects a considerable proportion of geriatrics in Egypt. Although hearing aid technology is improving, there is still a high prevalence of hearing aid rejection in elder population. Causes of hearing aid rejection in rural geriatric population were not investigated in previous researches. Objective: This study aimed to detect causes of hearing aid rejection in rural geriatric population. Patients and Methods: Thirty rural elders of both genders, ≥ 65 years old, with ≥ moderately severe hearing loss participated in this study. They were subjected to history taking, Hearing Handicap Inventory for the elderly, queries about causes of HA rejection in rural areas, and basic audiological evaluation. Results: Psychosocial causes of hearing aid rejection were the more prevalent (36.7%), followed by audiological (20%), cultural believes (16.7%), device, and organic causes. Factors such as age, education, self-perceived disability, type and degree of hearing loss, and speech intelligibility affect the prevalence of theses causes. Conclusion: Identifying causes of hearing aid rejection and factors influencing them helps proper modification of hearing rehabilitation strategies.