School attendance problems (SAPs) have traditionally been viewed as a result of behavioral challenges in student populations. Increasing evidence suggests, however, that a substantial portion of SAPs and school refusal behaviors are related to underlying anxiety in students. The school counselor, as an advocate for all students, is well-positioned to transform school response to SAPs and school refusal behavior to anxiety-informed approaches. This conceptual article reviews the literature surrounding anxiety-based SAPs and school refusal and suggests approaches for school counselors to implement in their districts.