There is growing recognition of the importance of ecosystem-based approaches for adaptation to climate change—it is a cost-effective measure that has multiple benefits and can overcome many of the drawbacks of more common engineering adaptation options. Vietnam has a rich biodiversity and is also one of the most vulnerable countries impacted by climate change. Climate change policies have been adopted at national and local levels as well as by sector, making Vietnam one of the nations to most systematically fulfill their obligation under the United Nations Framework Convention on Climate Change. Consequently, we have used Vietnam as a case study, to assess the integration of ecosystem-based approach to adaptation to climate change. We found that ecosystem-based adaptation is being implemented in some projects but, overall, is inadequately considered by Vietnam’s climate change policies. Instead, policies predominantly rename infrastructure projects as climate change adaptation and focus on hard solutions for disaster reduction, rather than responding to long-term climate change through ecosystem-based adaptation. Moreover, ecosystem-based adaptation projects have focused on only a few relevant types of ecosystems. Vietnam should revise its existing climate change policies and sectoral strategies to integrate ecosystem-based adaptation across different scales of governance. As other nations develop adaptation policies at different scales, the lesson from Vietnam is that engineering measures need to be balanced with ecosystem-based adaptation for more affordable and effective responses to climate change.