Over the past decade the problems of rural America have become increasingly apparent as part of the national political agenda. A major focus has been the concerns regarding mental health services for rural children and adolescents. The present study uses a four-wave panel design to examine the influences of the family and social context on adolescent mental health services use. Structural equation modeling and logistic regression techniques are used to test the viability of different methods of analysis when the primary dependent variables are dichotomous and badly skewed. Results show the importance of parental warmth and supportiveness, and the crucial role that mothers play in the mental health treatment of their children. Adolescents in families having mothers expressing high levels of mental health services stigma were significantly less likely to seek professional care for depressed mood or antisocial behavior, versus adolescents in families where the mother expressed low levels of mental health services stigma. Similarly, families with high perceived economic pressure were less likely to seek professional mental health care for their children than were families having low perceived economic pressure. Policy implications include the need to address family and social issues in the debate over health care reform, and to move beyond the present political fixation on cost containment.