In northen Vietnam, shrimp farming has in several provinces changed from extensive to intensive production. This change has brought a number of socio-cultural, economic and environmental challenges, including disease outbreaks and an increase in the application of antimicrobials and chemical compounds to prevent and treat diseases. This qualitative study sought to explore shrimp farmers' practices and experiences and the contextual influencers that impact on shrimp farmers' management of ponds in Nghe An and Quang Ninh provinces in Northern Vietnam. In-depth interviews and focus group discussions were conducted with 15 farm owners in each province, and with selected aquaculture technicians employed by the Vietnamese government. Participant observation was carried out during farm visits to gain insight into management practices and preventive and curative treatment. The results showed that farmers were uncertain about how to respond to disease and relied on trial-and-error experiments with antimicrobial products, as well as Chinese products without the auxiliary labels in Vietnamese. Low levels of trust towards government guidance, lead many farmers to be guided by the private and commercial stakeholders with which farmers had more regular contact. Even in this relation, a degree of mistrust was found. The farmers' summed-up their situation as “praying in four directions” [có bệnh thì vái tứ phương] or “playing a game with the Gods” [đánh bạc với trời]. Intensive shrimp farming may be highly profitable, but also a precarious enterprise. We discuss our empirical findings against three analytical concepts. Firstly chronic liminality, defined as an enduring uncertain livelihood situation. Secondly, cultural capital representing farmers' engagement with “know-how” of modern technology of intensive shrimp farming, and globalization. Finally the concept of agency, is applied to discuss farmers diverse actions aimed at gaining control over diseases. Applying these concepts as a lense to our data, brings into focus the fundamental experience of uncertainty and ambivalence. Our findings call for multipronged interventions going beyond a narrow focus on training of farmers and instead address the fundamental livelihood insecurity. There is also a need for increased control and enforcement of current legistation on use of antimicrobials in Vietnamese shrimp culture. Finally, there is an urgent need for government institutions and private companies to provide reliable, fast and reasonably priced diagnostic services to guide a prudent use of antimicrobials to control bacterial-associated diseases.