Sea-level rise and resulting salinity inundation are making many coastal areas increasingly unfavorable for rice production. This paper examines intensive and extensive adaptations to rice production in salinity-prone areas of the Mekong River Delta (MKD) of Vietnam using a two-year panel dataset of 788 rice-growing households. In terms of intensive adaptations, we estimate a fixed-effect regression model and find that salinity tolerant rice varieties (STVs) increase rice yields on fields that are not protected by salinity barriers, but overall economic benefits from STVs are limited by lower market prices compared to other varieties. In terms of extensive adaptations, farmers stop growing rice on 15% of survey fields. Probit and IV-probit model results reveal that falling rice profitability plays a significant role in these observed exits from rice production, while salinity barrier infrastructure, large rice field holdings, and community commitment to rice farming are associated with continued rice production. Development initiatives that support household adaptation to sea-level rise need to blend currently polarized policy options of investment in large rice sector infrastructure projects that lock farmers into intensive rice cultivation and of support farmer efforts to find alternative land uses in response to evolving market and environmental conditions.