Increasingly, students are grappling with threats to their mental wellbeing, yet teachers receive little formal education or professional development in mental health literacy and how to support students who experience mental health concerns or trauma. Given mental health disparities that exist for American Indian/Alaska Native students (AI/AN), it is of particular importance for teachers to understand how to identify and respond in a culturally sensitive way when mental health issues arise. For this reason, we conducted a survey and focus groups to examine the perspectives of teachers of AI/AN students attending a Northern Plains tribal school on student mental health. The teachers (n = 18) were almost all White and teaching in a school with exclusively AI/AN students. Findings from the survey indicated that a quarter of teachers were unsure about how to recognize students in need of mental health services and 63% were unsure about referral sources for students. Three themes emerged in the focus group data including a need for more services for students and families, uncertainty about how to support students, and a desire for improved communication among school staff about students' challenges at home. Across the themes, there was little discussion about how students' sociocultural positionalities as AI/AN youth in the United States might be contributing to challenges teachers observed, nor how social and cultural distance between students and teachers might be impacting their experiences. Implications of this work for culturally informed mental health literacy training for teachers are discussed.