One of the most critical impacts of sea level rise is that flooding suffered by ever larger settlements in tropical deltas will increase. Here we look at Ho Chi Minh City, Vietnam, and quantify the threats that coastal floods pose to safety and to the economy. For this, we produce flood maps through hydrodynamic modeling and, by combining these with data sets of exposure and vulnerability, we estimate two indicators of risk: the damage to assets and the number of potential casualties. We simulate current and future (2050 and 2100) flood risk using IPCC scenarios of sea level rise and socioeconomic change. We find that annual damage may grow by more than 1 order of magnitude, and potential casualties may grow 5–20‐fold until the end of the century, in the absence of adaptation. Impacts depend strongly on the climate and socioeconomic scenarios considered. Next, we simulate the implementation of adaptation measures and calculate their effectiveness in reducing impacts. We find that a ring dike would protect the inner city but increase risk in more rural districts, whereas elevating areas at risk and dryproofing buildings will reduce impacts to the city as a whole. Most measures perform well from an economic standpoint. Combinations of measures seem to be the optimal solution and may address potential equity conflicts. Based on our results, we design possible adaptation pathways for Ho Chi Minh City for the coming decades; these can inform policy‐making and strategic thinking.