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Medium-density mixed-housing is promoted in various countries as a means toward creating more sustainable settlements. It does, however, require residents to live closer to their neighbours, share outdoor spaces, and be more neighbourly than what may typically be required in lower density suburban neighbourhoods. Yet, how important are outdoor design and neighbourliness for the success of medium-density mixed-housing in a South African context? This article examines the perceived importance of a number of outdoor design and neighbourliness factors from the point of view of residents living in such developments in South Africa. A survey of 300 residents across 10 developments reveals the importance of both outdoor design and neighbourliness, particularly if children, women, and older residents are involved. Planners and designers should, therefore, include sufficient private and common outdoor spaces to address the needs of residents and to promote neighbourliness and consequently the social acceptability of this type of housing in South Africa.