Despite the availability of highly efficacious treatment for decades, TB remains a major global public health problem. Nearly one third of the world's population is infected with Mycobacterium tuberculosis (MTB) and hence at risk of developing active disease. Tuberculosis is a major cause of morbidity and mortality in Ethiopia, and the country belongs to one of the most affected high burden countries in the world. Presumptive tuberculosis cases which are individuals having cough duration of more than two weeks has been used as a quick TB diagnosis in rural settings. Determining the prevalence of presumptive tuberculosis cases in selected rural communities of north western and north eastern parts of Amhara regional state was the study objective. For this study 10 districts from North Gondar and North Wollo zones were purposefully selected and 26 kebeles were included where Kebeles selected randomly based on the district tuberculosis report. The study was cross-sectional conducted from March 15, 2016 to March 30, 2016. All households in the selected kebeles were considered as a study population. A house to house check was also used as message dissemination to all dwellers in the kebele to register presumptive tuberculosis cases and all reported to have the problem were registered. A pretested semi-structured questionnaire was administered to collect socio demographic and related information. The questionnaires were filled by data collectors and all the responses were kept confidential. The overall prevalence of presumptive tuberculosis at household level in both zones was 2%. A relatively higher household prevalence were found on Gebsye, Achera, Dib-bahir, Dabat Zuria, Kino, and Debot kebeles’ with 3.9%, 4.0%, 5.3%, 6.0%, 7.0% and 8.1%, respectively. The mean presumptive cases per kebele was 28 cases. Dibbahir (57 cases), Achera (64 cases) and Debot (102 cases) kebeles’ were found to have the highest count, which were more than twice the mean number of cases on the studied kebeles. The mean proportion of presumptive tuberculosis cases was found to be 441 cases per 100,000 population and the highest rates were found on Dabat Zuria, Achera, Dib-bahir, Kino and Debot kebeles’ with 912 cases, 939 cases, 1230 cases, 1466 cases and 1888 cases, respectively per 100,000 populations. The magnitude of presumptive tuberculosis cases in the study areas was relatively high. Intensive health education, early case detection, frequent surveillance, diagnosis, real causes of chronic cough identifications & treatment are suggested to reduce the probable spread of the tuberculosis to a wider population.