The municipality's geographical area of 14 000 km2 encompasses 18 towns and villages. These include the coastal towns of Doring Bay, Strandfontein and Papendorp. Larger inland towns include Ebenaeser, Lutzville, Koekenaap, Vredendal, Klawer, Trawal, Vanrhynsdorp, Nuwerus and Bitterfontein.
Small rural settlements Kliprand, Put-se-Kloof, Rietpoort, Molsvlei and Stofkraal also fall within the Matzikama municipal area. The largest town and also commercial and administrative headquarters of Matzikama is Vredendal, which lies about 300 km north of Cape Town. The town serves the agricultural community and is situated on the banks of the Olifants River.
The wine cellar in town is, in a year of good harvests, the largest in South Africa. Vanrhynsdorp is the most eastern town in Matzikama, an important commercial centre for the area’s sheep farmers and popular with visitors during the spring flower season starting in August. On the Atlantic coast, the most well-known town is Strandfontein, a small holiday village, popular with fisherman and seafood enthusiasts and host to the Madeliefie Makietie, a music festival held in October.