In a baseline assessment of 30 rural villages surrounding Shigatse City, Tibet, many people, especially women, identified low back pain as a serious health problem. Consequently, we aimed to establish the prevalence of such pain and to develop appropriate interventions. We did a cross-sectional study of the prevalence of low back pain and related functional disability using two-stage random cluster sampling. We included 499 adults aged at least 15 years from 19 villages. The point prevalence of low back pain was 34.1% (95% CI 27.9-40.3% [170 people]); the 12-month prevalence was 41.9% (35.5-48.3% [209 people]). 100 (20%) villagers had substantial functional disability associated with low back pain. Low back pain is likely to be an important and under recognised problem in rural societies like Tibet.