School mental health (SMH) programmes serve as a necessary niche within rural communities and aim to bring accessible care to youth who may otherwise go without mental health services. The following study evaluated the impact of mental health treatment provided by the Assessment, Support, and Counseling (ASC) Center, an SMH health initiative located within a high school in rural western North Carolina during the 2011-2012 school year. Participants were high school students between 14 and 18 years of age, predominately Caucasian (91.3%) and female (65.5%). Treatment was evaluated based on score change on the Youth Outcome Questionnaire using the reliable change index (RCI; Jacobson & Truax, 1991) to track changes in symptomatology. Following ASC Center treatment, 63% of the clinical sample was deemed to have improved or recovered based on the RCI. While the study did not use an experimental design (with associated cautions regarding interpretation of findings), the results suggest that a moderate dosage of cognitive-behavioural therapy provided to adolescents in the context of a rural SMH programme is associated with reliable change for the majority of youth who take part in the treatment.