The Mekong delta is experiencing rapid environmental change due to anthropogenic activities causing accelerated subsidence, sea-level rise and sediment starvation. Consequentially, the delta is rapidly losing elevation relative to sea level. Designating specific areas for sedimentation is a suggested strategy to encourage elevation-building with nature in deltas. We combined projections of extraction-induced subsidence, natural compaction and global sea-level rise with new projections of fluvial sediment delivery to evaluate the potential effectiveness of sedimentation strategies in the Mekong delta to 2050. Our results reveal that with current rates of subsidence and sediment starvation, fluvial sediments alone can only preserve elevation locally, even under optimistic assumptions, and organic sedimentation could potentially assume a larger role. While sedimentation strategies alone have limited effectiveness in the present context, combined with enhanced organic matter retention and interventions reducing anthropogenic-accelerated subsidence, they can considerably delay future relative sea-level rise, buying the delta crucial time to adapt.