Adaptation strategies are essential to manage water demand and ensure optimal use of available water resources under climate change. Identification and prioritization of adaptation options would greatly support decision-making in drought-prone Northwest Bangladesh. This study identified climate adaptation options by literature review and stakeholder consultation, then used multi-criteria analysis to evaluate and prioritize the options. The complexity of the options was also evaluated, specifically social, institutional, and technical obstacles to their local uptake. Seventy-two adaptation options were identified, spanning six sector categories. The options were further classified as in-system dependent, i.e., options that could be implemented by local actors, or as out-system dependent, i.e., options reliant on actions by external actors. Finally, they were defined as on-farm or off-farm strategies. Transboundary cooperation to increase surface water flows was ranked as the overall top-priority option, though this option is very complex and out-system dependent. Integrated water resources management and integrated crop management were the top-ranked options in the water management and crop production management sectors, respectively. Clustering scattered households and offering training programs in on-farm water management were the most and least complex measures, respectively. Stakeholders exhibited a clear preference for higher scale out-system dependent strategies, rather than in-system dependent options focused on changing the agricultural system itself to cope with climate change. Nonetheless, it is recommended that short-term and medium-term planning focus on opportunities to implement achievable adaptation measures within the local agricultural system. Investment in complex, externally dependent strategies is important for long-term planning.