The policies and practices of small college counseling centers have been neglected in the literature at a time when campus mental health services are under scrutiny. A national sample of 181 small campus counseling center directors responded to the Iowa Counseling Center Survey-Revised. Their responses were compared with information about large university counseling centers, as assessed in a previous national survey (Stone, Vespia, & Kanz, 2000). With a modal full-time staff of one, small centers faced professional isolation and diverse student needs. They were significantly less likely than large universities to employ psychologists, assign "DSM-IV" diagnoses, or use formal treatment plans. They were more apt to provide long-term therapy and follow-up with referred clients. Research, clinical, and training implications are discussed. (Contains 7 tables.)