School mental health (SMH) programs and services have grown progressively in the United States in the past two decades, related to increased acknowledgement of their advantages and prominent federal initiatives (e.g., No Child Left Behind Act President's New Freedom Initiative; 20(13). Nonetheless, SMH is an emerging and tenuously supported field with many issues in need of attention. In this article nine immediate challenges to the advancement of innovative and successful SMH policies and programs are highlighted. Considered together, these challenges suggest a picture of current SMH programs and providers, and their educator partners, operating under untenable circumstances. As the field moves forward, enhanced commitment to a true public mental health promotion approach provides a framework for concrete actions to be taken to advance an interconnected policy-training-practice-research agenda in school mental health.