The Mekong Delta, one of the most vulnerable regions to climate change, is the focus of international action for adaptation. Improved understanding of the exposures and perceptions at the local level will help residents to cope with natural disasters and future climate disruptions. In this study, we assess the exposure to floods that rural communities across the Mekong Delta are facing. Among the various natural disasters threatening the delta, extreme flooding is by far the most prevailing concern. By carrying out a field survey on 1350 residents, we characterize the flooding patterns and vulnerabilities of households in three geographically diverse provinces. The aim of this study is to assess the effectiveness of current flood adaptation in these households in conditions of regular flooding, as well as to extreme flooding events, which become more intense and frequent due to climate change. While the findings suggest varying degrees of coping with seasonal flooding by raising the ground floors of their homes, their capacity to prepare for extreme floods is limited in spite of the residents’ awareness of the changing dynamics of natural disasters in their locality. We also examine their perception to the effects of climate change and identify factors that influence their awareness.