The focus on geriatric mental health has a slow momentum in our country. The focus on the same in rural India remains sporadic, with a dearth of timely intervention. With a growing elderly populace, there is a need to focus on geriatric mental health, more so in the rural setup that has received lesser attention and resources. The glaring challenges around geriatric mental health in the rural areas of India are attributed to psychosocial factors, along with the lack of awareness and resource availability despite the district mental health programs in place, which remain underutilized. Despite the provisions of district and national mental health programs, there is a need to focus on the unique challenges in geriatric mental health such as depression and dementia, and treat them adequately. There is a need for greater awareness, equipped care, and liaison of services to ensure better care for geriatric mental health challenges. This chapter discusses in detail the challenges of geriatric mental health in rural India and briefly proposes a future care approach for this populace.