Background. Traditional medicine is the sum total of knowledge, talents, and practices that are used to uphold health, as well as to avert, identify, improve, or treat illnesses. Sociodemographic/economic characteristics, culture, and environment can influence the preference and practice of traditional medicine. Objective. To assess the preference and practices of traditional medicine and associated factors. Methods. A community-based cross-sectional study was conducted among 271 residents of Jimma town. The data were collected by interviewing selected households. The households were selected by a simple random sampling technique. The data were analysed using SPSS version 20. Descriptive statistics were used for organizing, describing, and summarizing the data. Chi-square (X2) test was used to identify factors associated with the preference and practice of traditional medicine. Results. More than half (221(81.5%)) of the participants practiced traditional medicine. Religion (X2 = 17.18; p = 0.001 ), marital status (X2 = 15.42; p = 0.001 ), occupation (X2 = 19.74; p = 0.001 ), and educational level (X2 = 28.39; p ≤ 0.001 ) were the sociodemographic factors determining the use of traditional medicine. However, 25 (9.2%) of the participants preferred to use traditional medicine. Affordability (25 (100%)), religious affiliation (21 (84%)), and distance from home (20 (80%)) were some reasons for preference. Educational level (X2 = 15.56; p = 0.04 ), marital status (X2 = 12.39; p = 0.04 ), and occupation (X2 = 15.61; p = 0.003 ) were the factors affecting their preference for traditional medicine. Conclusion. A majority of the participants practiced traditional medicine use. Religion, marital status, occupation, and educational level were factors affecting the practice of the participants. More than half of the participants did not prefer to use traditional medicine. Affordability, religious affiliation, and distance from home were some reasons for preferring traditional medicine.