While psychology has tended to focus on urban issues in research and practice, rural areas have undergone a series of changes in recent years that have increased the need for behavioral health services. A variety of social and economic factors has contributed both to the increasing needs and to the inability of the existing services to meet them. In this article, the authors survey the literature on rural behavioral health issues, focusing on children and adolescents, to highlight the status of knowledge and approaches to intervention. A conceptual rubric based on the social ecological perspective is used. First, what is known about rural behavioral health and health care for youth is described at the ontogenetic, micro-, meso-, and macrosystem levels. Strategies that have been proposed to address problems in rural behavioral health care are also presented at the different levels. General principles for future intervention and research are proposed that recognize the unique context of rural communities, use local knowledge and ideas, incorporate the efforts of informal systems of care using a strength-based approach, and identify and work toward solving the macrosystem issues that underlie rural health problems.