Poverty is a constant in rural life and can become intergenerational. The connection between poverty and mental illness is well documented. This chapter surveys the effects that high poverty levels have on rural communities, individuals, and families. Some of the effects are school consolidations, empty storefronts and malls, depopulation, workforce shortages, leaning silos, and dilapidated barns. Needs assessments are a highly viable way of gauging a community’s needs. The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Strategic Prevention Framework is presented as a reliable, free comprehensive tool that can be used in assessment. A case study is included.