A comparison of agricultural practices, with a specific focus on pesticide use, between rice and rice-fish farmers in the C?n Tho and Ti?n Giang provinces of the Mekong Delta in 2007, shows that integrated rice-fish farming can provide a competitive alternative to intensive rice mono-cropping, if the farmer restricts the use of pesticides and takes full advantage of the ecosystem services provided by the rice-field ecosystem. In C?n Tho, rice-fish farmers had significantly higher income (43.6 million dong ha-1 year-1) than other farmer groups, while this was not seen among rice-fish famers in Ti?n Giang (32.4 million dong ha-1 year-1), which partly could be due to a high use of insecticides (0.9 kg active ingredient ha-1 crop-1) and comparatively low fish yield among these farmers. The study emphasizes the need to rethink current agricultural systems and to provide opportunities for more diverse systems that maintain and enhance a range of ecosystem services and protect human health. Future production systems should not be optimized to only provide a single ecosystem service, such as rice, but designed to deliver a variety of interlinked ecosystem service such as rice, fish, pest control, and nutrient recycling.