Development in the Mekong Delta of Vietnam has been very dynamic in the recent past, and currently it stands at an interesting crossroads. On one hand, agricultural production has developed successfully, and economic growth has been very rapid, but on the other hand, intensifying agriculture and large-scale water-control structures have challenged the environmental sustainability and social equity. The development plans have included a strong belief in the human mastery over the nature and waters of the Mekong Delta. In many cases, water resources planners have underestimated the complexity and integrated nature of the ecology and livelihoods of the Mekong Delta. This article examines cases where development efforts, while successful in some dimensions, have also contributed to create new risks for, especially, the poorest groups. The current situation calls for a more sustainable future route that would require examination of more adaptive measures in relation to the changing water flows of the Mekong River.