This manuscript outlines the challenges and opportunities associated with rural mental health practice, and provides descriptive data on the scope of care, area of competence, and clinical training of a group of practitioners providing services in rural central Appalachia. Thematic content analysis reveals ethical challenges encountered, job satisfaction, and the pinnacles and pitfalls of mental health care practice in the region. Implications for training, recruiting, and retaining practitioners to work in underserved rural settings are described. The authors highlight a number of areas that need additional research attention in order to address remaining questions relevant to clinical practice in rural settings.

Rural lesbian youth are encumbered with a number of obstacles in their development of a positive self-identify and self-worth. Youth may experience implied physical threats, abuse, and mental health concerns as they attempt to define themselves within a context that emphasizes the role of women as heterosexual caretakers of the community. A number of factors can serve to diminish or enhance the young rural lesbian's ability to cope with barriers and obstacles that she may face, including having a supportive family network, a larger network of friends, supportive mentors and teachers, and access to gay-straight alliances. The intent of this article is to examine the challenges that rural lesbian youth face in developing a positive self-identity including tools to enhance resilience.

Mental health professionals practicing in rural areas face ethical dilemmas different from those experienced by their urban counterparts and may find that the existing ethics literature and American Psychological Association (APA, 2002) ethics code not particularly helpful. We highlight parts of five standards from the APA ethics code to illustrate the dilemmas rural practitioners frequently confront and offer suggestions for how to handle them. We discuss competence, human relations, and confidentiality as specific areas and then examine assessment and therapy as broader situations in which dilemmas may occur. We use case examples to highlight complications that may arise in rural areas.

Private practice in rural areas presents special challenges. Rural communities often hold more stigmatizing views about psychotherapy and have fewer economic resources, yet rates of mental health problems are comparable to those in metropolitan areas. Rural practice can be particularly rewarding for clinicians who can build collaborative networks, adjust to visibility, negotiate boundaries, and successfully integrate into the community. This article offers recommendations for mental health counselors on building a practice for branding, marketing, collaborating, and exercising self-care. It also discusses challenges associated with counseling in rural areas and gives suggestions for building a thriving practice.

Because of the high chronicity of work‐related problems in a Veterans Administration Medical Center population, many of the traditional methods of career assessment, counseling, and placement have proven ineffectual. In this article the authors detail the development of an intervention based on narrative or storytelling principles. They describe efforts to introduce this model to patients as well as to relate patients' stories to vocational outcomes. The usefulness of stories as an organizing principle for counselors and clients is discussed, and suggestions are offered for further uses of storytelling interventions.