This article studies the development of poor relief in the rural areas of the diocese of Tortona in the eighteenth century, through the analysis of the parish reports written for the pastoral visits of bishops Giulio Resta and Giuseppe Lodovico Andujar in 1741 and 1743. The reports record the most important assistance activities organised by different social actors: dowries for poor girls; bread, money and clothing to distribute to the poor; but also formal support in the form of hospitals providing shelter and care for pilgrims and the sick; the monti di pietà, which loaned money and the grain stores, which provided essential loans of grain. The diocese of Tortona in the eighteenth century represents a privileged point of view for understanding how the development of poor relief in the ancien régime was influenced by the political and institutional, geographical, landowning and socio-ecomomic context. Here, a complex institutional situation, combined with a diverse geographical and socio-economic context, gave rise to a variety of poor relief systems.