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A rise in anxiety and depression as well as increasing rates of suicidal ideations among youth have prompted urgent concern for researchers and educators. Although schools are looked to as viable centers for delivering mental health support services to youth, not all schools and their systems of support have sufficient capacities to address youths’ needs. Rural schools communities, in particular, face unique challenges to deliver supports for youth with mental health needs. This paper focuses on the experiences of sixteen mental health professionals working in six rural schools across New York State. Our findings provide critical insights to address youths’ mental health in rural areas as well as for future research and practical implications for school-based mental health professionals.