Cities in Latin America and the Caribbean (LAC) currently face many environmental and sustainable development challenges, with significant impacts on human health, resource productivity/incomes, ecological “public goods”, poverty, and inequity. In this context, climate change impacts in the region will exacerbate and create additional complexity, particularly in urban areas. For hundreds of millions of urban dwellers in LAC, most of the risks from the impacts of climate change are a result of development failures. For the urban poor, this fact is disproportionately true. This paper seeks to contribute to the limited body of knowledge regarding climate change, cities and the urban poor in the region, and to inform how institutions, governance and urban planning are keys to understanding the opportunities and limitations to possible policy and program advances in the area of adaptation.