As a rapidly developing country, Vietnam will witness a substantial growth in electricity demand in the coming decades. The surging demand will exert a huge pressure on the power transmission grid in the country. Therefore, this paper fully examines the challenges and opportunities for the power transmission grid of Vietnam. Firstly, the historical evolution and the prospected changes were reviewed, in terms of the energy demand, the production capacity, and the split in energy sources. Next, the current constraints on the power transmission grid were identified, which are related to the history and geography of Vietnam. On this basis, the authors expected that coal-fired energy production will increase in the short term, due to the rising energy demand and the limited new hydropower resources. Finally, several suggestions were put forward to improve the power transmission grid in Vietnam, namely, developing renewable energy sources, upgrading HVAC to HVDC lines, introducing MVDC links if conditions permit. The research provides a reference for the future development of the energy sector in Vietnam.