The dissertation examines how structural inequalities shape lived experiences of chronic illness. In particular, I explore how rural migrant workers struggle with kidney failure in China. This study is based on twelve months of ethnographic research in the hemodialysis ward of a public hospital in a remote, agricultural county in southwest China. Hemodialysis is a life-sustaining biotechnology for failing kidneys. From today’s biomedical perspective, patients suffering from kidney failure can live a long, normal life on hemodialysis. Health policies that address poor patients’ premature death from kidney failure usually focus on filling the shortage of medical resources and expanding access to hemodialysis. In China, increased coverage in social health insurance has made hemodialysis accessible to poor rural patients. Focusing on a group of young and middle-aged rural migrant laborers, this ethnographic account follows these patients’ various forms of life-and-death dilemmas, as they reason against the uneasy constellation of proliferating therapeutic options to prolong lives, loss of work abilities, and tenuous kinship relations. This dissertation unravels rural migrant workers' lived experiences of chronicity that challenge the conceptual binaries between care and abandonment, private and public responsibilities, and life and death. I show that the dire social and economic effects of chronic illness on underprivileged populations are experienced in ways that go beyond access. I argue that chronic disease care necessitates not only treating the disease but also the provision of equitable social security.