Disease and epidemics have been a constant presence throughout the history of humanity. In order to mitigate the risks of contagion, societies have long “adapted” to diseases, implementing an array of coping strategies that, in the long run, have had considerable economic and social consequences. This article advances the hypothesis, and documents empirically, that the need to alleviate the dangers of malaria shaped all aspects of life in agricultural communities, from where and how people settled, to how and what they could farm. As larger farms were better equipped to adopt these risk-mitigating strategies, centuries of exposure to malaria had important implications for inequality and wealth distribution.