With creativity and collaboration, children in rural communities who have the same mental health needs as children in urban areas can achieve access to mental health care. This review of the literature explores barriers to mental health services facing school-aged children residing in rural communities and focuses on how challenges unique to rural communities affect the type of care rural children ultimately receive. This review aligns with the NREA Research Agenda priority area "access to counseling/mental health services" (NREA, 2018). The discussion incorporates national trends in the treatment of children with mental health concerns and highlights some surprising facts about the state of mental health care in rural school and examines the following factors: (1) belief, (2) family poverty, (3) school support, (4) community resources, and (5) awareness. The review concludes by outlining opportunities for advocacy and proposed solutions for improving mental health care access for rural children and suggesting directions for future research.