Efrain Alegre of Concertacion centre-left coalition is leading narrowly in opinion polls and has vowed to reconsider ties with Taiwan if he wins.
Future ties with Taiwan are in play as Paraguayans go to the polls to pick a president they hope will tackle endemic corruption, rising crime and economic inequality.
In Sunday's election, a centre-left coalition is aiming to end the almost unbroken, seven-decade hegemony of the ruling conservative Colorado Party in the closest race in many years.
Some 4.8 million of the South American country's 7.5 million inhabitants are eligible to vote in the election for president and legislature that will be determined in a single round.
Lawyer Efrain Alegre, 60, of the Concertacion centre-left coalition is leading narrowly in opinion polls amid a recent anti-incumbency trend in Latin American elections.
His main challenger is Santiago Pena, a 44-Diplomatic battleground
The outcome could have important consequences for Paraguay's international relations, one of only 13 countries to recognise Taipei over Beijing.
But Alegre has vowed to reconsider this if he wins, telling the AFP news agency: "Relations with Taiwan mean the loss of one of the largest markets, which is China."
He added: "Paraguay makes a very big effort, a very big sacrifice to have relations with Taiwan, but we are not seeing from Taiwan the same effort."
China considers Taiwan part of its territory to be retaken one day, and does not allow other countries to recognise both Beijing and Taipei.
Honduras severed ties with Taipei in favour of Beijing last month.
It followed the footsteps of Nicaragua, El Salvador, the Dominican Republic, Panama, and Costa Rica in ditching Taiwan.
More than half of the countries still have diplomatic ties with Taiwan are small countries in Latin America and the Caribbean: Belize, Guatemala, Haiti, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines.
Paraguayan presidential elections are settled in a single, winner-takes-all round, and terms are constitutionally limited to one.
Voters will also decide the members of the legislature and choose 17 governors.year-old economist and former finance minister hoping to continue the rule of the Colorado Party that has governed almost continually since 1947.
Paraguay is ranked 137 out of 180 countries on Transparency International's Corruption Perceptions Index.