Indigenous aid workers carry out the majority of humanitarian aid work, yet there is little empirical information available on their support needs in different contexts. Focus groups (N = 26: Study 1) and a survey (N = 137; Study 2) were conducted with Guatemalan aid workers to explore their exposure to violence, posttraumatic stress symptoms, burnout, support needs, and motivators. Participants reported experiencing an average of 13 events of community violence and 17% reported symptoms consistent with posttraumatic stress disorder (PTSD). Direct community violence exposure and levels of emotional exhaustion were positively related to PTSD symptoms, while levels of personal accomplishment were inversely related to PTSD symptoms. Expressed support needs, motivators and rewards for aid work in the face of adversity are also reported as potential protective factors for further exploration. Implications for training and support of aid workers in similar contexts are also suggested.