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This article studies the causes of China's Great Famine, during which 16.5 to 45 million individuals perished in rural areas. We document that average rural food retention during the famine was too high to generate a severe famine without rural inequality in food availability; that there was significant variance in famine mortality rates across rural regions; and that rural mortality rates were positively correlated with per capita food production, a surprising pattern that is unique to the famine years. We provide evidence that an inflexible and progressive government procurement policy (where procurement could not adjust to contemporaneous production and larger shares of expected production were procured from more productive regions) was necessary for generating this pattern and that this policy was a quantitatively important contributor to overall famine mortality.