Until now, research on mental health service utilization in rural populations has focused on environmental barriers, sociodemographic barriers, and cultural barriers to seeking mental health care; considerably less attention has focused on cognitive appraisals such as individual perceptions of need, outcome expectancies and outcome value. Demographic and environmental characteristics, cultural perceptions of seeking help for emotional problems, cognitive appraisals, and current psychiatric symptoms were assessed in one model that predicted mental health service utilization in a rural sample. There were several hypotheses proposed: (1) Psychiatric symptoms will be positively related to mental health service utilization; (2) There would be higher utilization for medical care versus specialty mental health care; (3) There would be a higher perception of need and outcome expectancy for primary care than for specialty mental health care; (4) A higher number of environmental barriers would predict lower specialty mental health service utilization; (5) An increase in cultural barriers would predict lower specialty mental health utilization; and (6) Cognitive appraisals of specialty mental health care services would significantly predict specialty mental health care utilization above and beyond the effect of psychiatric symptoms, demographic variables, environmental barriers, and cultural barriers. The results of this study support the hypothesis that cognitive appraisals have an impact on the decision to seek specialty mental health services in a rural sample. Study findings, limitations, and implications are discussed.