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This mixed-methods study investigates stress and coping among URM Physician Assistant (PA) students. A survey of 2,065 graduating PA students assessed stress using the Perceived Stress Scale (PSS) and a qualitative inquiry about coping with stress. Qualitative analyses identified eight coping strategies. Regression analysis revealed URM status is linked to increased stress in all models except those involving physical/recreational activities. Positive relationships between stress and both emotional regulation and substance use/risk behaviors were identified, while physical activities and social support were associated with decreased stress. The interaction between URM status and substance use was statistically significant, suggesting a weaker impact on stress for URMs. These findings underscore the need for targeted interventions and tailored support for URM PA students.