Construction of extensive high dike compartments has spurred land use intensification on the upper floodplains of the Vietnamese Mekong Delta. Increasingly intense rice-based farming within these compartments has changed the water dynamics of the delta, making it impossible to exploit the erstwhile benefits of floodwaters. Progressive contraction of the natural floodplains has led to reduced deposition of fertile sediments and environmental degradation, endangering the sustainability of farmers’ livelihoods. The Mekong Delta Plan recommends discontinuance of high dike construction in the upper delta and restoration of the floodplains. However, this requires a radical shift in the agricultural economy, halting intensification of rice-based farming systems and developing alternative farming systems that can flourish on restored floodplains using “living with floods” livelihood strategies. This paper explores stakeholders’ perceptions and appreciation of these contrasting farming and livelihood systems for the upper delta. It also examines the extent that alternatives to flood-based agricultural systems are viewed as feasible and attractive. We applied multi-criteria analysis (MCA) with analytic hierarchy process (AHP) to explore the views of double and triple rice farmers and experts on alternatives based on a set of economic, water management and environmental aspects. MCA results indicate a clear preference among both farmers and experts for flood-based farming systems with low dikes. Floodwater retention capacity, infrastructure for flood protection, environmental sustainability, and market stability were ranked as the most important factors contributing to livelihood sustainability on the delta.