This study examines what kinds of background variables predict stigma and what impact stigma has on the utilization of formal mental health services. Prior research indicates that gender, age cohort, rural versus urban residency, and socioeconomic status have differing effects on utilization. A model of health behavior was tested using data from a panel study of 1,487 adults in the state of Iowa. The results indicate that stigma reflects the use of formal mental health services and that the impact is different for men and women. For women, stigma has a direct effect on utilization of formal mental health services and for men stigma has an indirect or moderating effect on symptoms of mental illness and utilization of formal mental health services. Rural residency also was predictive of stigma for men but not for women.