Increasing tourism and population growth, exacerbated by migration, are placing pressure on the health and resilience of natural resources worldwide. This is evident in complex tropical coastal systems, particularly Small Island and Small Island Developing States (SIDS), where limited resources, fragile environments and climate change risk result in sustainable development challenges. The relationship between residents' perceived impacts of tourism, marine resource health, and support for future development was investigated through face-to-face semi-structured interviews with 57 stakeholders, including heads of households, fishers and those working in the tourism sector, on the Island of Grand Turk (Turks and Caicos Islands). Perceptions of the economic, social and environmental impact of tourism were not significantly associated with residents' socio-demographics. However, Turks and Caicos nationals were significantly more likely to support future tourism development than non-nationals. Residents that linked tourism with environmental degradation showed significantly reduced support for tourism development. Proposed developments which promote overnight tourism were viewed most positively by respondents highlighting a need for strategic growth of the tourism sector to consider income generation outside of the cruise terminal. Results highlight the need for more balanced consideration of the effects of tourism on socio-economic factors along with environmental considerations in communities highly depended on marine resources. Thus, context-specific understanding of residents’ perceptions and how this might influence support for future development is vital to building policies that are reflective of local priorities.