Clergy members have the unique opportunity to improve mental health treatment access and decrease the service need gap in rural communities. Very little is known about their role in referring older adults with depressive symptoms to mental health providers. The aim of this study was to examine predictors of rural, mainline Christian clergy members’ intentions to provide counseling to older congregants with depression/refer to another clergy member versus refer to a mental health provider. A cross-sectional, Internet-based survey was distributed to clergy in two rural states. Participants were presented with case scenarios depicting an older adult with mild-to-moderate and moderate-to-severe depressive symptoms. Predictors of intent to counsel or refer to a mental health provider were examined. Of the 101 clergy members who completed the survey, the majority referred to a mental health provider as opposed to providing counseling themselves or referring to another clergy member. Clergy with high depression knowledge and strong endorsement of an organic etiological model of depression were more likely to refer to a mental health provider, χ2(11) = 28.56, p = .003. Qualitative findings suggested a complex approach to referral, including factors such as congregant characteristics. Interventions to enhance the clergy’s knowledge about late-life depression and mental illness etiology as well as skills to provide brief, evidence-based depression treatment to older congregants may improve mental health treatment access in rural communities. Likewise, programs that facilitate collaboration between clergy members and mental health providers may further support rural mental health care.