El Alto International Airport serves La Paz, Bolivia, and sits at an altitude of roughly 4,000 meters (about 13,300 feet), making it one of the highest major commercial airports anywhere in the world, a fact that shapes almost every part of the car-rental experience here. Rental desks inside and near the terminal are operated by a mix of international and local companies, and pickup itself is routine, but the altitude affects both visitors and vehicles: expect noticeably reduced engine performance in normal combustion cars, and give yourself time to acclimatize physically before undertaking a long mountain drive right after landing.
From El Alto, the road down into La Paz itself is dramatic, dropping several hundred meters in elevation over a short distance as the city spills into the canyon below the altiplano, with La Paz's downtown core sitting noticeably lower and warmer than the airport plateau above it. Bolivia drives on the right, and beyond the immediate La Paz area, routes fan out toward Lake Titicaca to the northwest, a few hours away, and south toward Oruro and, eventually, the Uyuni salt flats, a much longer multi-day undertaking best planned with real buffer time built in.
Mountain roads throughout this region can be narrow, unpaved in stretches, and subject to landslides or rough surfaces during the wet season roughly November through March, so a vehicle with good clearance is worth requesting for anything beyond paved city routes. Altitude sickness is a genuine concern for visitors flying directly into El Alto, and driving demanding mountain roads on your first day is not advisable; most experienced travelers spend at least a day adjusting in La Paz before attempting a longer highland drive from this exceptionally high-altitude gateway city.
Fuel and basic services thin out once you head into remote highland stretches, so topping up before a long day trip is a sensible habit worth confirming with the rental desk before setting out.