School attendance is a complex topic for all school stakeholders preparing students for college and career success. Students who refuse to attend or avoid school are affected or influenced by a myriad of reasons such as their own physical or mental health issues. This article explores the various factors at the root of school refusal, particularly anxiety. Considering students' possible sources of distress, cognitive-behavioral and mindfulness interventions are discussed as well as other strategies across a multi-tiered system of supports model. Three case studies provide insight into various interventions that school counselors and other school personnel may use in school refusal situations.