The aim of the present study is to investigate the attitude of the small and medium hotel enterprises which operate in regions of massive tourism development towards the principles of sustainable tourism development. For the achievement of the goal we depended on the already existent literature, in order to determine, comprehend and present the theoretical framework which will guide the empirical research. Therefore, the focus was on the secondary data, which substantiate the research approach we adopted. Then, we formed a structured questionnaire which was distributed to sixty eight small or medium hotel enterprises in the prefecture of Pieria. The questionnaire, after its statistical processing, provided useful information about the profile of the hotel enterprise, as well as the importance of the expected profits for the hotel SME from the successful sustainable tourism development in the tourism region of the prefecture of Pieria.