This chapter explores policy and parity in rural mental health. Beginning with a timeline of significant mental health developments from 1840 through the present, it focuses on modern developments in the field such as the Institutions for Mental Diseases (IMD) exclusion; Jimmy Carter’s President’s Commission on Mental Health; George H. W. Bush’s Decade of the Brain, which culminated in the President’s New Freedom Commission on Mental Health; the Mental Health Parity Act of 2008 and its enforcement; and Barack Obama’s Affordable Care Act (ACA) with its implications. It concludes with the development of the 21st Century Cures Act and the Medicaid Redesign Program.