The career development concerns of American Indians continue to receive limited attention in the vocational or career literature. To address this deficit, the current article will apply the cultural formulation approach to career counseling with American Indians. This article presents information on factors related to cultural and self-identity for American Indians, followed by a discussion of a culturally informed perspective on career concerns. A discussion of therapeutic issues and a case study of a young Lakota woman are provided. The article concludes with suggestions for how to approach the case using the cultural formulation approach.