This study describes the global casino and casino tourism boom. It investigates in detail the social, economic and environmental consequences of casino gaming in Macao since casino license liberalization in 2002. Building on earlier quantitative studies, in-depth face-to-face interviews with 17 key community leaders elicited their professional views on the impact of casino gaming on the community. The community leaders suggest that although casino gaming does make positive social, economic and environment contributions to the community, greater effort is needed to minimize its negative social and environmental consequences. Issues that need addressing include the changing values of teenagers, the high student drop-out rate, problem gambling and crime, changing family relationships, increasing tension between public needs and casino land requirements, traffic congestion, and air and noise pollution. Macao residents' acceptance level of the further development of casino gaming is found to be high, and their perceptions of its impact can be explained by the social exchange theory, rather than by social disruption theory. The results of this paper shed light on the community impact of casinos, and offer policy and governance implications for destination managers in Macao and other destinations with, or intentions to develop, casinos and gaming-related tourism. © 2012 Copyright Taylor and Francis Group, LLC.