This study examined principal perspectives on barriers and strengths or assets associated with the delivery of school mental health services in their school and considered whether the common determinants that principals identify vary by geographic locales (i.e., city, suburban, town, and rural). Participants were 638 principals from across the four locale categories. Principals completed open-ended survey questions that addressed perceived barriers and strengths or assets with the delivery of school mental health. Thematic analysis was conducted of principal responses. There were differences in the most common barriers principals identified across locale. For example, principals in suburban areas identified lack of personnel, principals in cities identified a lack of a shared understanding about mental and behavioral health and associated services, and principals in towns and rural areas identified financial concerns as primary barriers in addressing student mental health needs. Across all four locales, the most common stated strength or asset in schools was having school-based mental and behavioral health personnel and resources. Implications for practice and future research are discussed.