This article focuses on difficulties that people with disabilities and reduced work capacity experience in employment and social participation, and on their rehabilitation goals, in order to make recommendations for policy and social and vocational rehabilitation service provision. A semi-structured interview procedure, which included the World Health Organization Disability Assessment Schedule 2.0, was used to conduct initial needs assessments with 85 persons in Estonia. Quantitative and qualitative data were gathered and analysed using descriptive statistics and thematic analysis. Results revealed that participants experienced multiple difficulties, which they mostly ascribed to unstable health conditions, that limited their abilities to participate in employment and social activities. A large number of participants also identified themselves as unemployed for health reasons and linked their rehabilitation goals to health restoration rather than becoming employed. Difficulties such as lack of work skills, unsuitable work tempo, mobility limitations, and emotional problems were also mentioned. To support people with disabilities in obtaining and maintaining employment, services must correspond to the persons´ need; and comprehensive, person-centred rehabilitation assessment, service planning, and budgeting mechanisms are needed. Supportive legislation, flexibility in service provision, and the availability of needs-based rehabilitation and other services, including lifelong learning opportunities, are also necessary to help people learn new work skill