<p>School-based mental health services offer an effective way to address the unmet mental health needs of children and youth, and evidence-based models such as Comprehensive School Mental Health Systems (CSMHS) provide schools with a framework to implement such services. Current studies related to school-based mental health systems focus on outcomes rather than process, and few examine the experiences of educators supporting implementation in school districts. This study highlights findings from a process evaluation of a statewide initiative supporting school districts and regional educational agencies in implementing CSMHS. The authors collected data through virtual focus groups with 38 participants who were employed in Regional Educational Agencies implementing CSMHS, then analyzed it to identify themes. Results highlight the importance of collaboration at the regional and state level, staff buy-in, and alignment of the CSMHS model with existing initiatives, such as Multi-Tiered Systems of Support (MTSS). Finally, results identify some unique challenges that rural schools experienced during implementation, including stigma around mental health, limited capacity of school staff, and scarce community resources.</p>