Depression among adolescents has been trending upward with approximately 3.2 million adolescents aged 12-17 having at least one major depressive episode in the United States (U.S.) in 2016. The incidence of depression also rises with age among adolescents, with depressive episodes at 4.8% for 12-year-olds, 11.8% for 14-year-olds, and as high as 18.5% in adolescents aged 17 years. Interventions aimed at understanding mental health needs of adolescents and reducing barriers to care are essential to improve overall health outcomes for this population. The goal of this community needs assessment was to better understand adolescent mental health and determine the needs of adolescents who experience mental health problems in rural areas. A qualitative approach was used to elicit the perspectives of adolescents, healthcare providers, educators, and parents regarding the mental health needs of adolescents in rural North Dakota. Individual, semi-structured interviews were conducted with a total of ten participants from the four target groups. Facilitators to maintaining mental health were identified as support from family/friends, healthy diet, adequate sleep, limiting social media, avoiding video games, and physical activity. Barriers to discussing and accessing mental healthcare included stigma, confidentiality/privacy, shortage of mental health professionals, lack of routine discussion, lack of a standardized curriculum in schools, time, lack of understanding by adolescents, and healthcare provider/parent relationship. Based on the interview results, recommendations were made to school administrators and clinic personnel to address the needs of adolescents in rural areas with mental health problems. Recommendations for school administrators included a universal approach to address students about mental health and implementation of a mentor program. The clinic received recommendations for implementation of telehealth services to expand capabilities and implementation of youth-friendly services to create a more welcoming environment for adolescents. The results of this community needs assessment revealed that adolescents identify anxiety and depression as top health priorities; however, barriers, such as fears of judgement, stigma associated with mental health, and lack of access to care, may prevent them from seeking care. Further research is needed to identify resources and interventions to improve the overall health and well-being of adolescents in rural areas.