Given that few youth with mental health service needs actually seek help, understanding their perceptions of barriers is important. We examined principal individual, community, and systemic barriers to help-seeking, and compared barriers by population density (rural/small city), gender, age, and mental health status. Questionnaires were delivered to Cape Breton High School students. Stigma, lack of education, and awareness about resources emerged as prevalent barriers. Individual level barriers were a greater concern for rural youth; small city youth were more affected by systems level barriers. Finally, an interaction effect was found whereby rural youth with no mental health issues were least likely to report community level barriers as impediments to help-seeking.