Livestock plays a pivotal role for smallholder production systems in mountainous Northern Vietnam. Poor rural farm households are vulnerable and their livelihood systems are often so fragile and finely-balanced that a small misfortune can destabilize the households for many years. Economic risks, especially loss of livestock, are one of the major reasons for slipping into poverty. Normally, insurance systems could step in here. In developing countries however, insurance markets are usually underdeveloped. Empirical research reveals that raising livestock and selling it in case of a livelihood emergency is a particularly popular risk management strategy. Based on the results of a computer-based Adaptive Conjoint Analysis (ACA) with 155 responding households of different ethnic minority groups in Son La and Bac Kan provinces of Northern Vietnam, this article examines insurance preferences of rural farm households. In general, smallholders are very interested in livestock insurance. The ‘insured animal’ is the most important attribute for all respondents and the buffalo is the highest valued animal. However, the critical issue is how to design the insurance package. It is argued that the provision of adapted livestock insurance could help decreasing household vulnerability by a forward looking risk management strategy. Insurance preferences of smallholders are presented and policy recommendations are given to improve the overall situation of vulnerable households in mountainous Northern Vietnam.