Hydropower, although an attractive renewable energy source, can alter the flux of water, sediments, and biota, producing detrimental impacts in downstream regions. The Mekong River illustrates the impacts of large dams and the limitations of conventional dam regulating strategies. Even under the most optimistic sluicing scenario, sediment load at the Mekong Delta could only recover to 62.3 ± 8.2 million tonnes (1 million tonnes = 109 kilograms), short of the (100 to 160)-million tonne historical level. Furthermore, unless retrofit to reroute sediments, the dams are doomed to continue trapping sediment for at least 170 years and thus starve downstream reaches of sediment, contributing to the impending disappearance of the Mekong Delta. Therefore, we explicitly challenge the widespread use of large dead storages-the portion of the reservoirs that cannot be emptied-in dam designs. Smaller dead storages can ease sediment starvation in downstream regions, thereby buffering against sinking deltas or relative sea level rises.