The Amazon River delta may be currently characterized biophysically as a relatively preserved delta compared to the rampant vulnerability of many of the world’s large deltas. This status of relative preservation is reflected in a number of criteria: The still largely free-flowing nature of many of the rivers and the main stem of the Amazon that feed the delta in sediment, exceptional biodiversity, dominant shoreline accretion, and the absence of anthropogenically-generated subsidence. In this review, we show that these relatively reassuring conditions are progressively being called into question by the effects of dams on fluvial sediment supply to the delta, by increasing demographic, urban, and land development pressures in this still largely underpopulated delta, and by problems of governance that underplay aspects of basin-wide and deltaic environmental deterioration. A major challenge is that of bringing together these contrasting demands that are leading to the emergence of zones of environmental stress that test the resilience of this delta. An integral part of the strategy for the analysis of collective action, management, and conservation is that of considering the Amazon delta in terms of interacting socio-ecological systems. Pressures on the delta will be compounded in the future by decreasing fluvial sediment supply and sea-level rise. Although climate change is projected to generate surplus sediment, the rapid growth of dam constructions upstream of the delta will negatively impact the river’s sediment flux. Conservation and management of the Amazon River system aimed at keeping the delta resilient in the context of sea-level rise and reduction of sediment supply will require clear governance and better planning and anticipation, as well as socio-ecological integration. These are also requirements that will need to be implemented in the 1500 km-long coastal zone of the Guianas countries located west of the Amazon delta and the sediment dynamics and stability of which are largely determined by sediment supply from the Amazon.