Mental health and suicide prevention in rural communities are vital concerns. While there are many similarities in the mental health problems experienced by urban and rural dwellers, living and working rurally can impose particular stresses which may lead to mental health problems, and, for some, suicide. National mental health strategies need to be customised to ensure service delivery and support to rural people, and tailored to provide rural solutions to specific rural stresses, including problems such as loneliness, harmful alcohol use and access to firearms. Challenges and strategies of rural mental health and suicide prevention include: improving access to treatment; educating primary care professionals to screen for and manage depression, hazardous alcohol use, and suicide risk; educating community gatekeepers about mental health and suicide prevention; encouraging the use of online resources; clarifying local pathways to care and establishing crisis response protocols appropriate for the local community; and targeting suicide prevention programmes to community risk profiles and needs.