[2] Historically, Samtse was sparsely populated as the mountain-dwelling Bhutanese considered the low-lying district to be prone to tropical disease.

[2] During the early 20th century, the district experienced a large influx of Nepali people who were invited to the area to assist in forest-clearing.

[3] Samtse is also home to the Lhop (Doya) people, a little-studied ethnic group of approximately 2,500 persons.

The Lhop are noted for their animistic religious beliefs, their practice of marrying cross-cousins, and their unique burial customs.

Samtse is also home to some of the autochthonous communities of Bhutan, pre-dating the arrival of Nepali and Dzongkha speakers.

Cardamom, ginger, areca nut, and oranges[2] are the predominant cash crops, although most farmers practice subsistence farming.