This study was designed to examine the environmental exposure of surface- and groundwater pollution in remote mountainous regions of northern Vietnam. In 2008, we monitored the loss of four commonly applied pesticides (imidacloprid, fenitrothion, fenobucarb, dichlorvos) from paddy rice farming systems to a receiving stream on the watershed scale and quantified groundwater pollution. For the entire monitoring period, runoff loss of pesticides from the watershed was estimated to range between 0.4% (dichlorvos) and 16% (fenitrothion) of the total applied mass. These losses were correlated well with the octanol–water partition coefficient and water solubility of pesticides (r2 = 0.78–0.99). In the groundwater collected from eight wells, all target pesticides were frequently detected. Maximum measured concentrations were 0.47, 0.22, 0.17, and 0.07 µg L−1 for fenitrothion, imidacloprid, fenobucarb, and dichlorvos, respectively. Our results strongly indicate that under the current management practice pesticide use in paddy fields poses a serious environmental problem in mountainous regions of northern Vietnam.