The general objective of this paper is to present and discuss the factors that need to be taken into account to ensure that the development and management of religious tourism at rural sites was sustainable from an economic, environmental and socio-cultural point of view. Among other issues, sustainable religious tourism means accessibility to the sanctuaries, protection of cultural and heritage values of the local community, benefits for the local residents and meaningful experience for visitors. Authors were especially interested in the less popular, more remotely located holy sites in Mazovia Region (Poland) and two concerns: readiness to respond the needs of persons with different disabilities and local community opinion on tourists. As was documented by our research outcomes despite the recent numerous improvements, the most popular rural sanctuaries in Mazovia Region, remain only partially accessible for persons with disabilities. As masses of pilgrims have a significant effect on wellbeing and everyday life quality of residents (contributing both to positive and to negative effects), those who accept that tourists are important for economic development, benefit from it, creating ‘smart host area’. These rural communities which are not knowledgeable about positive impacts – see only negative consequences.