The combined effect of race and place of residence on caregivers' perceptions of children's mental health services is underresearched. Differences in caregiver strain, barriers-to-care endorsement, and provider satisfaction are examined among 175 rural and urban African American caregivers from one Southern state whose children received Medicaid sponsored mental health services. Children exhibited clinical levels of externalizing and internalizing mental health symptoms and high levels of co-occurring physical health problems. Almost one quarter were cared for by someone other than biological parents. Almost all caregivers reported strain associated with children's mental health problems, compromised personal health status, and high levels of depression. Family perception barriers (such as concern about potential negative reactions of significant others) were most endorsed. Most caregivers were satisfied with their children's mental health services, with lowest levels on the provider sensitivity subscale. Initial rural-urban differences in caregiver strain did not remain significant in multiple regression analyses after other covariates were included. (Contains 4 tables.)