This study investigates the effects of improved market accessibility on agricultural land use and basic wellbeing, defined by income and rice sufficiency, in Xayaburi province, Lao PDR through a meso-scale and actor-oriented approach with data collection at both district and household level. It also investigates farmers' decision-making as it relates to regional markets. Increasing market accessibility in rural areas facilitates cash crop trade leading to agrarian change from subsistence to commercial agricultural systems. This transformation raises concerns about food security and vulnerability to market uncertainties as farmers are likely to grow cash crops intensively and in place of food crops, leading to lower food production. Meanwhile incomes from cash crop trade are highly vulnerable to market uncertainties. We found that farmers in the south of Xayaburi, where market accessibility is higher than in the north, primarily grow cash crops and do not suffer from rice insufficiency while farmers in the north, where market accessibility is lower, rely more on subsistence agriculture and have a lower level of basic wellbeing. The major factors of better basic wellbeing in the south include: (1) better market accessibility which can mitigate the risks of market uncertainty and create enough income to compensate for and overcome losses in rice production, (2) availability of more arable land due to a larger amount of level terrain which allows farmers to expand cash crop cultivation and continue growing rice at the same time, and (3) farmer strategy to keep a part of their land for growing rice to meet their minimum consumption needs and prevent the risks of rice insufficiency.