The American-China rivalries in almost all spheres, ranging from diplomatic, trade, technological to ideological, have inevitably affected Malaysia’s foreign policy options including its relations with China. This chapter is organized into three main parts. The first part briefly examines the factors leading to the resurgence of Mahathir including the opposition alliance’s anti-China rhetoric. The second section of the paper discusses complex domestic factors and variables in shaping Malaysia’s engagement with China and its stance in the great power politics, under the new foreign policy framework that was announced in June 2019. The third part analyses Malaysia’s policies toward the BRI through a case analysis of the East Coast Rail Link project as well as the American-China trade war by examining Mahathir’s positions on Huawei which is at the centre of the trade dispute between the two powers. The concluding section explores the implications of Malaysia’s dilemmas in a broader context of international political economy and highlights the important roles of local agency (interests, institutions, and players) in engaging great power politics.