As universities worldwide expand their use of English as the medium of instruction (EMI), its impact varies sharply across linguistic contexts. In many African higher-education settings—where English is seldom students’ home language—the shift to EMI creates distinct pressures, especially in accounting programmes that demand high levels of conceptual processing. This study explores how educators in multilingual classrooms navigate these pressures in both rural South Africa and urban Namibia. Guided by cognitive load theory, the research draws on qualitative insights from educator questionnaires and interviews. The findings show that students’ limited command of English heightens the inherent difficulty of specialised accounting material, increasing intrinsic cognitive load. At the same time, the coexistence of several local languages, particularly in rural classrooms, adds additional layers of extraneous load. Although both rural and urban lecturers rely on English to establish a common instructional platform, their approaches to managing linguistic complexity differ. Rural educators often turn to code-switching as a practical tool for easing comprehension, whereas their urban counterparts emphasise redesigning learning materials and using institutional resources to support students’ processing of new concepts. Overall, the study highlights the importance of institutional investment and responsive curriculum design to help educators balance cognitive demands in EMI environments. Such support is essential for creating equitable learning conditions in multilingual accounting classrooms.