China’s experiences with addressing extreme poverty and marginality are presented and analyzed. The evolution of effective and efficient policies, especially in rural areas is found closely connected to China’s economic growth in the past three decades, as well as to regional inequality. The “Di Bao” (minimum livelihood guarantee system) in different areas is reviewed. In developed regions, the “Di Bao” social assistance program, social insurance and public services have effectively mitigated the difficulties of the extremely poor. In poor areas, however, addressing extreme poverty and marginality remains a challenge. Increasing the effectiveness of poverty reduction efforts in poor areas is, and will continue to be central to the eradication of extreme poverty in China.