Student-athletes experience unique stressors and challenges that impact both their mental health and athletic performance. The current study sought to explore these stressors and challenges; examine how they relate to help-seeking, service access, and utilization; and recommend what colleges and universities can do to better support the mental health of student-athletes. Three focus groups were conducted with NCAA Division I student-athletes in upstate New York between November 2019 and October 2020. Student-athletes described significant stress juggling athletic, academic, and social demands while maintaining a performance level that met the expectations of their coaches and themselves. Student-athletes were also impacted by an unhealthy athletic culture and team environment, specific higher-risk transition periods, and inaccurate beliefs about student-athletes held by their non-athlete peers. While many athletes reported struggling with their mental health, they felt either unable or unwilling to seek help due to stigma, how it would appear to their coaches, the hours and location of the counseling center, and previous poor experiences accessing and utilizing services. The authors present a set of multi-tiered recommendations to help increase awareness, access to, and utilization of both on- and off-campus mental health services, resources, and supports.