With more than 60 percent of China's 1.34 billion population, about 50 percent of its most productive arable land, and the world's second largest and rapidly growing national GDP exposed to flooding of various kinds, China has an intractable flood problem. Envisioning potential impacts of climate change and continued intensification of floodplain development driven by rapid industrialization and urbanization, it is very likely that China will see a continued increase of exposure to floods this century. This overview article outlines and discusses fundamental dilemmas, plausible pathways, and key options for managing future flood risks in China in the context of rapid socioeconomic transition and climate change. Fundamental dilemmas are the embedded difficult trade-off choices, from balancing economic development with flood vulnerability reduction, to coordination and cooperation among increasingly diverse actors and across scales. Among plausible pathways, this article argues that a resilience strategy for managing flood risk is desirable. It would require human adjustment to flood, not by aiming for full protection and control but by adjusting our use of floodplains, integrating and experimenting with a wide range of flood risk management options, so that a dynamic balance is maintained between exposure and coping capacity and flood risk is contained at an acceptable level. Embracing variability and uncertainty lies at the heart of such a flood resilience centered paradigm. Reducing the flood toll cannot be had without trade-offs in economic development, food production, and agricultural productivity.