This cross-sectional study was undertaken to determine the prevalence of tobacco smoking and to obtain information on socio-demographic factors associated with tobacco smoking among adult males in a rural district of Sindh Province, Pakistan. We used a one-stage cluster sampling frame to identify 411 adult males from the study site. We found a high prevalence, 55% of current smokers among this rural population. The median age of initiation of smoking was 20 years. Awareness of the adverse effects of smoking on lung and heart diseases was 86% and 77%, respectively. Smoking prevalence increased with age and income, and was highest among subjects aged 44 years and above (76%) and with incomes of more than PKR 4000 (72%). The high prevalence of smoking suggests that there is an urgent need for developing intervention plans to address this major public health problem in this region.