In this study, the performance of different aluminium hydroxide.based adsorbents was compared in terms of fluoride adsorption capacity, potential for repetitive regeneration, surface acidity and surface site concentrations. The adsorbents were aluminium hydro(oxide) (AO), activated alumina (AA), and pseudoboehmite (PB). The AO adsorbent was synthesised at different OH:Al ratios to optimise the fluoride adsorption capacity. The AO was pilot tested in a rural community in the Ethiopian Rift Valley where groundwaters are heavily enriched with fluoride. The maximum fluoride uptake was achieved for the AO adsorbent synthesised at OH:Al ratios between 2.5 and 2.7. The fluoride adsorption capacity of the adsorbents determined from mini-column studies was found to be 10.6, 1.9, and 2.4 mg/g for AO, AA, and PB, respectively. This significant difference in fluoride adsorption capacity is strongly related to the surface acidity and surface site concentration. The surface acidity (1.57 meq/g) and surface site concentration (0.74 meq/g) for AO is higher than that for AA and PB. The elemental composition analysis showed that AO has a lower % Al2O3 content than AA and PB, but higher sulphate (19.4%) and iron (2.2%) content. High resolution 27Al Magic Angle Spinning Nuclear Magnetic Resonance (27Al MAS NMR) spectra of AO, AA, and PB were recorded, to analyse the coordination geometry of solid Al species and the results showed that aluminium is coordinated octahedrally and tetrahedrally in all cases. Regeneration experiments showed that AA and PB can be regenerated for more than 3 cycles, whereas the potential for regeneration of AO for more than 3 cycles is limited. The results from a community defluoridation plant showed that fluoride in the feed water (8.10 mg/.) is removed below 0.1 mg/.. The average adsorption capacity was determined to be 2.11 mg/g based on continuous field monitoring results obtained until the fluoride content in the treated water exceeded the breakthrough value of 1.5 mg/.. No major operational problems and complaints from the beneficiaries were experienced during operation. Keywords : fluoride, adsorption, surface acidity, regeneration, defluoridation, Ethiopia