Adaptation to climate change has been recognized as very important in developing countries that face the greatest threats from global warming. In proposing various adaptation approaches, the United Nations Intergovernmental Panel on Climate Change required nations to prepare adaptation plans of action. However, the areas of priority in climate change adaptation have not been considered. This study has developed a new prioritization methodology for climate change adaptation in developing countries. Five categories and 25 approaches in climate change adaptation were adopted through a thorough and detailed analysis of pertinent literature related to the National Adaptation Program of Action (NAPA) in the Gambia. A fuzzy analytic hierarchy process-based questionnaire survey was designed and presented to 12 experts chosen from the committee members of the Gambia’s NAPA. The survey was made to determine the relative importance of the strategies for climate change adaptation. The results indicate that the five most important adaptation categories are health (0.223), forestry (0.213), water (0.210), food (0.181), and energy (0.174), with health as the number one priority in climate change adaptation. Further findings show that the prioritization order of the adaptation approaches to climate change in the Gambia is as follows: “Health education,” “public sensitization,” “water supply infrastructure development,” “microfinance,” and “infrastructure and technology enhancement.”