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Purpose – The purpose of this paper is to understand how and why small to medium enterprises (SMEs) access knowledge from external actors in general and from higher education institutions (HEIs) in particular and what is the extent to which these knowledge access pathways affect SME innovativeness. Design/methodology/approach – The paper involved both quantitative and qualitative approaches: a survey of 1,226 SMEs and a mini case study to follow-up on issues arising from the survey analysis. Survey data were analysed using both non-parametric and multivariate Poisson regression analysis. The case study was based on a medium-sized manufacturing firm in South Australia. Findings – While there are significant differences between the micro-, small- and medium-sized enterprises, the evidence suggests that SMEs generally use “generic” university–industry knowledge transfer pathways (e.g. published research results) rather than university–industry links with high “relational” involvement. More significantly, the results indicate that SMEs are more likely to rely on organisations other than universities and related R&D enterprises for knowledge acquisition like clients/customers or suppliers. While collaboration is most likely to occur within the same state/territory, or Australia, many SMEs also collaborate internationally, usually as part of normal supplier–customer relationships, reinforcing knowledge acquisition from organisationally proximate partners. These findings are also supported by the case study. Research limitations/implications – This research was limited to surveying SMEs in one geographic (metropolitan) region in Australia. It also does not account for the different patterns of HEI–SME interactions in different industry sectors. There is also only one case study. Originality/value – First, the research adds to the few field studies that have investigated accessing knowledge for innovation among SMEs. Specifically, the research contributes to an understanding of the heterogeneous roles that different actors play in facilitating knowledge access for improving innovative SMEs outcomes. Second, the research does not treat all SMEs similarly in terms of size effects but instead accounts for differing SME sizes and how this affects their selection of knowledge access pathways. Third, the research contributes to a small number of studies that attempt to understand how HEIs and SMEs can work better together in the context of a regional innovation system, especially one that is relatively less competitive to the larger economy.