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Communication issues occur when foreign doctors from different cultural backgrounds have to treat local patients and attempt to establish rapport across cultures in order to diagnose correctly and advise treatment in a way that is acceptable to the patient. This paper reports on strategies used by Iranian and Nigerian medical doctors in public hospitals in Limpopo, South Africa, to establish and manage rapport in the opening sequence of their first meetings with local rural patients. The study used a conversation analysis method to examine the interaction of Iranian and Nigerian doctors with local South African patients against the background of Spencer‐Oatey's rapport management framework and cultural maxims of greetings and forms of address in the two countries. Recordings of opening sequences of consultations were examined to provide an understanding of the doctors' linguistic behavior. Consultations conducted by six doctors were recorded, transcribed, translated where necessary and analyzed against the background of the Rapport Management Framework. All the Iranian doctors were found to adopt different strategies from the Nigerian doctors even though both countries are classified as high‐context cultures and would be expected to use similar communication strategies. The findings have implications for the induction of foreign medical doctors in South Africa. [ABSTRACT FROM AUTHOR]