diff --git a/ChangeLog.d/fix-rsaalt-test-guards.txt b/ChangeLog.d/fix-rsaalt-test-guards.txt
new file mode 100644
index 0000000000..f4f39c9e53
--- /dev/null
+++ b/ChangeLog.d/fix-rsaalt-test-guards.txt
@@ -0,0 +1,3 @@
+Bugfix
+   * Fix compile error where MBEDTLS_RSA_C and MBEDTLS_X509_CRT_WRITE_C are
+     defined, but MBEDTLS_PK_RSA_ALT_SUPPORT is not defined. Fixes #3174.
diff --git a/tests/scripts/all.sh b/tests/scripts/all.sh
index 1e10da04c1..bf40764921 100755
--- a/tests/scripts/all.sh
+++ b/tests/scripts/all.sh
@@ -1948,6 +1948,18 @@ component_test_depends_py_pkalgs_psa () {
     tests/scripts/depends.py pkalgs
 }
 
+component_build_no_pk_rsa_alt_support () {
+    msg "build: !MBEDTLS_PK_RSA_ALT_SUPPORT" # ~30s
+
+    scripts/config.py full
+    scripts/config.py unset MBEDTLS_PK_RSA_ALT_SUPPORT
+    scripts/config.py set MBEDTLS_RSA_C
+    scripts/config.py set MBEDTLS_X509_CRT_WRITE_C
+
+    # Only compile - this is primarily to test for compile issues
+    make CC=gcc CFLAGS='-Werror -Wall -Wextra -I../tests/include/alt-dummy'
+}
+
 component_build_module_alt () {
     msg "build: MBEDTLS_XXX_ALT" # ~30s
     scripts/config.py full
diff --git a/tests/suites/test_suite_x509write.function b/tests/suites/test_suite_x509write.function
index a21ad475a8..03b9baea39 100644
--- a/tests/suites/test_suite_x509write.function
+++ b/tests/suites/test_suite_x509write.function
@@ -345,7 +345,7 @@ void x509_crt_check(char *subject_key_file, char *subject_pwd,
 
     issuer_key_type = mbedtls_pk_get_type(&issuer_key);
 
-#if defined(MBEDTLS_RSA_C)
+#if defined(MBEDTLS_RSA_C) && defined(MBEDTLS_PK_RSA_ALT_SUPPORT)
     /* For RSA PK contexts, create a copy as an alternative RSA context. */
     if (pk_wrap == 1 && issuer_key_type == MBEDTLS_PK_RSA) {
         TEST_ASSERT(mbedtls_pk_setup_rsa_alt(&issuer_key_alt,