This article discusses some of the dramatic changes seen in college mental health issues over the past 2 decades. These modifications are a consequence of many factors: changes in our health care system (managed care), new effective biological treatments (medications), the focus of psychiatric training (biologic focus), technology advances (Internet, electronic records, and e-mail), and changes in the student body and campus life ("helicopter" parents, overextended youth). The author asserts that there is a need and opportunity for psychiatrists to play an important role in this evolution, in collaboration with other campus mental health professionals.