This study examines rural and urban differences in the use of children's mental health services and the role that family income, health insurance, and mental health status play in explaining these differences. The analysis is based on three years of pooled data from the National Survey of America's Families (NSAF). Three research questions are examined: (1) What is the mental health need of children, age 6 to 17? (2) What percentage of children, with an identified mental health need, used a mental health service in the past year? What is the average number of mental health visits they received in the past year? (3) What role does family income and type of insurance have on the use of mental health services by children? Analyses show that rural and urban children both face substantial barriers to use of mental health services. Medicaid and SCHIP help all children, but particularly rural children who receive mental health care. This suggests that these public health insurance programs are important policy vehicles for enhancing the access of rural children to mental health care.