Sarajevo Mayor Alija Behmen officially opened the restaurant on the Bosnian capital's main street, named after Marshall Tito, and made the first food order.
Behmen said McDonald's presence sent a strong signal to badly needed foreign investors.
He also dismissed fears that hamburgers would undermine the lofty place of cevapcici, a traditional grilled minced-meat dish that is revered in the Balkans and beyond.
"Has McDonald's put pizza in danger in Italy or sausages in Munich? This will only broaden the choice," Behmen said.
One young boy who was brought to the new McDonald's by his grandparents for a Big Mac, fries, and a cola, agreed with the mayor.
"It was awesome," he said. When asked which is better, cevapcici or hamburgers, he said that "both are great."
McDonald's first expressed interest in the market in Bosnia-Herzegovina more than a decade ago. But it only started preparing to launch the Sarajevo branch in 2007 -- after long bureaucratic delays and other hindrances.
McDonald's operates in 118 countries. It opened its first restaurant in the region in Belgrade in 1988, followed by one in the Croatian capital, Zagreb, in 1996.
The company has plans to open several more outlets in Bosnia.