Tourism contribution to Macao’s gross domestic product in 2013 was 86% positioning it as a global leader in terms of reliance on tourism revenues, to which casinos contribute over 90%. Most Macao residents are linked to tourism’s economic success yet this study shows the rapid development has created negative sentiment toward the industry and specifically casinos. While acknowledging economic benefits, this study showed residents were concerned more about traffic congestion, overcrowding, and living costs with a greater wish for improved public transportation and leisure offerings and less casino development emphasis. A tourism development strategy firmly focused on tourism diversification issues was urgently suggested.