Historically, the trade benefits of medicinal plants have been skewed towards technologically advanced Northern countries, despite originating from the biologically rich South. Since the 1990s, attempts at rectifying this situation have been stepped up globally. In southern Africa, a substantial industry has developed around the use of the endemic plant Pelargonium sidoides as a cure for respiratory tract infections. Rural communities harvest the plant for trade and also hold traditional knowledge about it. However, the industry has been plagued by concerns about the sustainability of the resource and equitable sharing of benefits, and accusations of ‘biopiracy’. This study examines the value chain to identify blockages preventing better benefit capture by the rural poor. We conclude that the Biodiversity Convention offers opportunities for redress but that monopolistic control, complex and uncoordinated laws, elite capture of benefits and increased cultivation undermine benefit sharing. These problems need to be overcome if rural communities are not to lose their benefits to large corporations exploiting Pelargonium sidoides