The purpose of this qualitative study was to identify and prioritize the mental health needs of rural communities in Texas Public Health Region 11 utilizing the Delphi method. Rural individuals face unique challenges when attempting to receive treatment for serious mental illness and mental health care. Stigma, a lack of privacy when seeking treatment, a shortage of mental health workforce professionals, a lack of culturally competent care, affordability, and transportation are all factors that complicate the need for treatment. This study utilized the Delphi method to engage rural community members in identifying and addressing critical issues related to mental healthcare delivery in their county. The sample for this study was selected from the population which comprise Texas Public Health Region 11 communities that were identified as rural communities within Health Professional Shortage Areas (HPSA) using an exponential nondiscriminatory snowball sampling method. Knowledge gained from the study will help to address challenges and critical issues in mental healthcare delivery in rural communities, such as workforce shortages, access issues, anonymity, stigma, integration of mental health services into primary care, and suicide prevention. The study's implications for refining, developing, and increasing rural mental health research, and implications for practice for mental health treatment providers in rural communities are discussed.