By the 2050s, more than 120 million people are predicted to settle in the Pearl River Delta (PRD), which covers large coastal cities such as Guangzhou, Shenzhen and Hong Kong. Cities in the PRD are vitally important to China in relation to their socio-economic contributions. From recent evidence, this strongly urbanized area is vulnerable to, and currently facing bigger incidences of, coastal and urban flooding. Flood risk is growing in low-lying coastal areas due to rapid urbanization and increasing flood hazards exacerbated by climate change. Frequent intensive rainstorms, sea-level rise, typhoons and surges threaten large populations and their economic assets, causing severe socio-economic and ecological impacts in the PRD cities. Current flood risk management (FRM) in the delta is still predominately focused on using traditional techno-fixes and infrastructure paradigms, lacking sufficient strategic planning and flood protection to develop adequate flood resilience. Recent urban floods, enhanced by storm surges and intensive rainstorms, have affected multiple PRD cities and drawn attention to flood risk as a major challenge in the PRD's coastal cities. This review encourages development of long-term FRM practices with provincial and municipal authorities working together more closely to develop better-integrated regional FRM strategies for the PRD.