This article describes the results of a qualitative investigation of social changes and challenges for rural adolescents who have a traumatic brain injury (TBI). We interviewed adolescents with mild to moderate TBI and their mothers using an iterative approach based in grounded theory. Interviews focused on social adjustment and interaction as well as environmental variables, especially those related to the adolescents' rural status. In-depth interviews produced multifaceted and interrelated social process themes expressed by participants in the study. Four umbrella themes emerged, which were personal change, environmental response, social needs, and facilitators and inhibitors of intentional changes (FIICs). These themes, and their subthemes, capture both assets and needs as they develop over time and provide guidance for both researchers and practitioners working with adolescents who have a TBI.