The current study investigated parental perceptions of the availability of mental health services for elementary-aged children, as well as barriers to care including expectations of treatment process, relationship, and outcome. Parent data from two rural Appalachian Ohio areas were contrasted with that from an urban Ohio sample matched for SES so that beliefs across community types could be examined. Using anonymous questionnaire methodology, parents were surveyed about their perceptions of children’ mental health care in their respective communities. Parents provided responses to open-ended questions about what services are available in their community, and were then asked to rate the acceptability of these services. Further, they were provided with a checklist of various agencies or entities and were asked to denote those agencies that are available in their respective communities. Data were also gathered about parents’ preferred sources of referral for children’s mental health services, Appalachian heritage, and whether or not their child has ever received such services. Finally, parents responded to modified versions of the Barriers to Treatment Participation scale (Kazdin, Holland, & Breton, 1991) and the Expectations of Mental Health Care survey (Richardson, 2001). Results suggest that rural parents view community mental health centers as primary sources of mental health support for their children, whereas urban parents viewed medical institutions (e.g., pediatricians, hospitals) as their preferred source of such care. As anticipated, issues of relationship and trust with the therapist were particularly salient for individuals in the rural county areas of Appalachian Ohio, compared to those living in a rural city in the same region. This study presents one of the first examinations of children’s mental health care in rural areas, and is unique in its study of Appalachian regional effects. Findings from this study may serve to inform providers in underserved areas such as rural Appalachia how barriers including poverty and parent perceptions of mental health treatment may have differential effects in geographically isolated areas versus more metropolitan centers.