China's 2010 census revealed a population of 1.34 billion, 50 percent urban, 13.3 percent above age sixty, and with 118.06 boys born for every 100 girls. In this article, we discuss how gender imbalance, population aging, and their interaction with rapid urbanization have shaped China's reform era development and will strongly shape China's future. These intertwined demographic changes pose an unprecedented challenge to social and economic governance, contributing to and magnifying the effects of a slower rate of economic growth. We organize the analysis according to the proximate determinants of economic growth: first, labor input and its productivity; second, capital investment and savings; and finally, multi-factor productivity, including social stability and governance. We argue that the economic, political, and social context that turns labor and capital inputs into economic outputs is perhaps the most important and least understood arena in which demographic change will shape China's rise.