In the densely populated regions of East Africa, small and medium-sized towns are said to play an important role in the rapidly changing urban-rural interface. They are home to many dynamic SMEs, which are active in trade and services. Yet their integration into relational systems is asymmetric: while they are central in inflows (supplying rural zones), in outflows (collecting and distributing agricultural produce) they encounter fierce competition from rural and urban stakeholders (farmers’ cooperatives, large companies, and middlemen). Through these SMEs, what is at stake is the role of secondary towns in current systems of economic and spatial integration.