There exists a high probability of a great earthquake rupture along the subduction megathrust under the Mentawai Islands of West Sumatra in the near future. Six rupture models were used to assess the tsunami inundation and the accompanying sediment movement in Painan, West Sumatra, Indonesia. According to a worst scenario, the potential tsunami might hit the coast of Painan about 26 minutes after the rupture and the entire city could be inundated with a maximum inundation depth of about 7 m. Severe erosion may also occur in the near-shore region. Two scenarios, one scenario with a positive leading wave and the other with a negative leading wave, were selected to simulate the tsunami-induced morphological changes. A positive leading wave would cause severe erosion in the shoreline area and a large sandbar in the offshore area adjacent to the shoreline; a small amount of sediment could be deposited in the city area; a negative leading wave could cause moderate erosion in the further offshore area due to the strong retreating wave front, an offshore sandbar could form in the bay area, while no noticeable large area of sand deposit could be found in the city area. The difference in the erosion and deposition patterns between these two scenarios provides very helpful information in the investigation of historical tsunamis through tsunami deposits.