Studies on technology adoption typically assume that a user’s perception of usability and usefulness of technology are central to its adoption. Specifically, in the case of accessibility and assistive technology, research has traditionally focused on the artifact rather than the individual, arguing that individual technologies fail or succeed based on their usability and fit for their users. Using a mixed-methods field study of smartphone adoption by 81 people with visual impairments in Bangalore, India, we argue that these positions are dated in the case of accessibility where a non-homogeneous population must adapt to technologies built for sighted people. We found that many users switch to smartphones despite their awareness of significant usability challenges with smartphones. We propose a nuanced understanding of perceived usefulness and actual usage based on need-related social and economic functions, which is an important step toward rethinking technology adoption for people with disabilities.