In March of 2020, many school systems transitioned to fully virtual platforms in an attempt to stop the spread of COVID-19. In the following months, schools remained online, transitioned to hybrid (partially online, partially in-person) models, or reopened completely. School-based mental health professionals (SBMHPs) remained responsible for meeting the mental health needs of students in the school system, regardless of the setting. This study sought to find out how COVID-19 and the subsequent changes in school setting have impacted SBMHPs. Through ethnographic observations of a nonprofit providing school-based mental health services as well as qualitative interviews with SBMHPs, this study uncovered a range of impacts. SBMHPs experienced an increase in demand for support with meeting basic needs and improving attendance and academics. Further, SBMHPs continued to provide counseling and crisis response services; however, these services had to be significantly adapted for each unique school setting (virtual, hybrid, and in-person). Despite these significant role changes, SBMHPs were adaptive and continued to meet the needs of students.