The role of (entrepreneurial) universities as change agents in regional economic development has been highlighted before, but how they can drive regional sustainable development in developing countries has been largely neglected hitherto. Using qualitative methods, we show how being confronted with adverse poverty and pollution in the local context, can drive a university to develop a sustainability vision that accordingly becomes the driver of institutional change. We demonstrate how local campus leadership, a holistic teaching and research program, and student involvement ensued significant local effects in the short run. Yet, we also show how liabilities of smallness hinders the creation of significant sustainable local impact. Instead, ...