The microscopic physics behind low-lattice thermal conductivity of single-crystal rock salt lead telluride (PbTe) is investigated. Mode-dependent phonon (normal and umklapp) scattering rates and their impact on thermal conductivity were quantified by first-principles-based anharmonic lattice dynamics calculations that accurately reproduce thermal conductivity in a wide temperature range. The low thermal conductivity of PbTe is attributed to the scattering of longitudinal acoustic phonons by transverse optical phonons with large anharmonicity and small group velocity of the soft transverse acoustic phonons. This results in enhancing the relative contribution of optical phonons, which are usually minor heat carriers in bulk materials. © 2012 American Physical Society.