Abstract The Red River Delta (RRD) of Vietnam, one of the world’s most densely populated deltas, is already vulnerable to flooding events, and climate change forecasts project increased exposure to flood risk in coming decades due to changes in rainfall, storm intensity and frequency, and sea-level rise. However, there is a relative neglect of this region in the literature on natural hazards and climate change, particularly on how floods in the RRD might affect poor people and different livelihood sectors, how flood risk is understood and acted on, and how flood impacts experienced by households influence local adaptation choices. This article presents research undertaken in 2009–2010 to understand the impacts of flooding in a typical rural zone (Thai Binh Province) of the RRD to assess overall vulnerability, particularly the relationship between poverty, livelihoods, and flood impacts, as well as to assess the range of adaptation and flood risk reduction options currently used. Our findings indicate that while poor households do not appear to be more exposed to floods than others, their incomes are more sensitive to relative impacts from floods. Yet poverty alone did not explain flood vulnerability, as age of household and livelihood sector involvement showed stronger relationships to flood impacts. Flood risk perceptions were also uneven, but poor people did not seem to take less proactive flood risk reduction measures than others. There are few long-term adaptation actions to flooding being taken by households of any income class, and there is a need for better community and government aid after flood events to help households cope with increased flood risks in the RRD, rather than relying on improvements in hard infrastructure, as is currently the dominant approach in the region, particularly given future forecasts of increased rainfall for northern Vietnam under climate change.