A limited literature suggests relatively simple feeding regimes and diet formulation strategies for dairy cows in Vietnamese smallholder dairy farms (SDFs). This study aimed to classify and compare feeding regimes and nutrient balance for lactating cows between four typical dairy regions (south lowland, south highland, north lowland, and north highland) in Vietnam and evaluate the possibility of systematic dietary imbalance. Eight SDFs from each of the four regions were visited for two adjacent milking periods per farm. For each visit, frequency and methods of feed and water supply to the lactating cows were recorded, and individual fat corrected milk yield (ECM) of lactating cows were calculated from milk yield and fat concentration. The amount of each diet ingredient offered and refused by each lactating group was weighed and sampled for calculation of dry matter intake per cow (DMI) and analysis of nutrient composition in the component offered. PCDairy, a diet formulation computer model, was used to calculate actual and recommended dietary nutrient concentrations and predict potential milk production. Factor analysis, cluster analysis, and ANOVA were applied to determine grouping effects across as well as between regions. Feeding regimes and diets were grouped into three and nine clusters, respectively. Farmers in the same region tended to apply similar diets and feeding regimes. Across regions, only 47% of all SDFs supplied water ad libitum to the cows. The most used roughages including Napier grass, corn silage, fresh corn with cob, and rice straw were all relatively high in neutral detergent fibre (NDF), acid detergent fibre (ADF), and acid detergent lignin (ADL). The diets in all regions were excessive in crude protein, NDF, ADF, ADL, and most minerals (Ca, P, Mg, K, Na, S, Fe, Zn, Cu, and Mn) but insufficient in net energy and non-fibre carbohydrate. Feed efficiency (1.06 kg FCM/kg DMI) of the diets were sub-optimal. Feeding regimes and dietary nutrient balance of the south lowland SDFs were most problematic. Increasing dietary net energy concentration by increasing the use of starch and fat and decreasing dietary fibre concentration by decreasing the use of Napier grass or rice straw to balance the diets might help improve the milk production and thereby increase feed efficiency.