Health care providers practicing in rural settings face unique challenges, including a lack of behavioral health providers and training specific to the provision of rural mental health care for older adults. Even with the formation of the National Rural Health Advisory Committee in 1987, rural older adults still encounter barriers to adequate behavioral health services. In rural health care, this can be described as the “three-part problem”: accessibility, acceptability, and availability (Smalley et al., 2010). This article provides an overview of the current state of rural behavioral health care in the United States, the importance of the Triple Aim initiative, and applying flexibility with the integration of behavioral health services into rural primary care settings. Specifically, the integrated Primary Care Behavioral Health consultation model will be discussed in the context of rural care for the older adult. Additionally, future directions addressing the training of behavioral health providers are discussed.