This chapter assesses human health risks of inorganic arsenic (As) from drinking well water and consumption of rice irrigated by high-As groundwater in the Mekong River Delta. Geogenic inorganic As (iAs) occurring at elevated levels in groundwater has been detected in more than 70 countries. Among mostly rural residents relying on groundwater for drinking, this exposure has resulted in negative health consequences including visible skin lesions, multiple internal organ cancers, numerous invisible non-cancer health effects such as cardiovascular diseases, and premature deaths. In the Mekong River Delta (MRD, defined by elevation <10 m above sea level in this book), As issues in groundwater have been documented as early as 1999 in Cambodia, with literature reporting its occurrence in Vietnam since 2005. Since the early 2000s, efforts have been made to test for As in about 100,000 wells from Cambodia, Laos, Vietnam and Thailand. Here, a combined dataset with a total of 94,768 unique As tests was analyzed to illustrate the spatial patterns and to assess the health risks of drinking well water As in Cambodia and in southern Vietnam. Although knowledge is far more limited, an attempt was also made to examine the potential health risks associated with iAs exposure from rice, a major staple for the MRD. Here, irrigation using highly As enriched groundwater for rice cultivation has expanded this environmental health problem from the hydrosphere (water) to the geosphere (soil) and, in turn, the biosphere (rice, and ultimately humans). Of 41,928 tests in Cambodia, 35.8% exceeded 10 μg/L, the WHO guideline value for drinking water As, while 21.5% exceeded 50 μg/L, the Cambodian drinking water standard. Of 52,858 tests in Vietnam, the exceedance rate for 10 μg/L, which is also the Vietnamese drinking water standard, is 10.0%. High As wells, regardless of whether it is relative to 10 or 50 μg/L, are located in proximity to the main course of the Mekong-Bassac Rivers, especially within a 5 km distance. The vast majority (>98%) of high-As wells are located in low-lying areas, i.e. <25 m elevation in Cambodia and <10 m elevation in Vietnam. High-As wells occur frequently at shallow depths (<70 m) across the MRD but also at deeper depths (300–500 m) in Vietnam. Due to the clustering of high As wells along the Mekong-Bassac Rivers, extreme human health tolls are identified in 11 districts of Cambodia and 3 districts of Vietnam with a population attributable fraction exceeding 0.1, meaning that >1 in every 10 adult deaths is solely due to drinking water As exposure. The annual excess deaths attributable to arsenic exposure alone is 1204 in Cambodia and 1486 in Vietnam, or 1 in every 27 adult deaths and 1 in every 78 adult deaths, respectively. In addition to uncertainties in bioavailability and toxicity of iAs in rice grains, soil and rice As data, especially rice As speciation data needed for risk assessment, are still limited in the MRD.