Climate change impacts in the Mekong River Delta (MRD) require national responses. However, national control of these problems may be impractical where mitigation of climate impacts may have negative consequences for small-scale farmers’ livelihood and food quality objectives. In response to these problems, this chapter examines a set of possible climate change management approaches with clear links to the small-scale farmers and future sustainable food objectives in the MRD. The adoption of organic rice varieties may provide appropriate transformational solutions, with some caveats on implementation based on our analysis. General insights on how to support rice farming systems through interventions for rice farmers in the MRD while addressing climate change impacts at the local level are also provided at the end of the chapter.