In Rwanda for the past decade, rural households have lived with civil unrest and genocide, changing land laws, large population flows both into and out of the country, and climatic threats with droughts and floods. The illness and untimely death of prime age adults from a number of health problems (increasingly HIV/AIDS) adds to the stress of these households and has lasting effects on the ability of households to survive. In this research, the authors use household and member level survey data to increase understanding about what is happening in households with such shocks and how they may be different from other Rwandan rural households. This research finds that households affected by adult illness and death strive to maintain their agricultural production, and work to avoid selling assets, yet some households appear to be in a downward spiral, losing assets and income earning potential. They rely heavily on social networks for labor and skills, but clearly these networks will be stretched beyond their means in any continuing epidemics. Female-headed households in particular struggle to find labor with neighbors or work more themselves. If special programs are developed for the affected families, focusing on increasing land and labor productivity fits into their own strategies. Since households with prime age death and disease appear to be similar to other Rwandan households in the poorest two quintiles, such programs would be beneficial to rural households in general, and possibly strengthen social networks through generalized agricultural and income growth.