Utilization rates of counseling services by international students continue to be low despite the growing presence of this population in American colleges and universities. There are a number of adjustment factors and stressors that can have a detrimental impact on the mental health and well-being of international students, as well as a variety of barriers to accessing supports. This study examined international student utilization of counseling services at a Midwestern University over a period of 5 years. Results indicated that international students underutilized counseling services in all but one year examined, more female international students used the service than males, the majority of international students who did access counseling services were Asian, and the majority of students who accessed services kept appointments after intake sessions. Limitations and implications of the study are discussed.