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Artificial intelligence (AI) technology has been increasingly used in the implementation of advanced Clinical Decision Support Systems (CDSS). Research demonstrated the potential usefulness of AI-powered CDSS (AI-CDSS) in clinical decision making scenarios. However, post-adoption user perception and experience remain understudied, especially in developing countries. Through observations and interviews with 22 clinicians from 6 rural clinics in China, this paper reports the various tensions between the design of an AI-CDSS system (“Brilliant Doctor”) and the rural clinical context, such as the misalignment with local context and workflow, the technical limitations and usability barriers, as well as issues related to transparency and trustworthiness of AI-CDSS. Despite these tensions, all participants expressed positive attitudes toward the future of AI-CDSS, especially acting as “a doctor’s AI assistant” to realize …