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Abstract Word-of-mouth (WOM) personal referrals are more efficient and influential than other forms of advertising; however, there is a lack of information regarding the value of referral programs. The purpose of this qualitative case study was to explore the perceptions of business owners, staff, and customers of alternative health care organizations in a Midwestern U.S. state about efficient referral strategies, measuring the effect of those strategies, and motivations of consumers to make referrals. Maslow's hierarchy of needs theory of motivation and customer decision-making theories provided the conceptual framework. The research questions addressed how industry leaders perceived and ranked referral strategies and addressed customers' perceptions and motivations to make personal referrals. Data collection consisted of semistructured interviews with 4 business owners, 2 staff members, and 10 client participants. Data were analyzed using constant comparative analysis methods, and member checking enhanced the accuracy of the findings. Results indicated that participants viewed WOM personal referrals as the most efficient nontraditional strategy to make or receive referrals, and they perceived referrals from impartial and trustworthy sources as the most valued information. This research has implications for positive social change. Findings may be used to enhance business owners' understanding of the value of personal referrals in their marketing mix, and of the motivation for customers to make referrals. WOM personal referrals may be used as a marketing strategy to increase sales and lower costs of formal advertising, which may contribute to the growth of the business.