Research has consistently demonstrated the benefits of school mental health (SMH) services on the well-being of students. Administrators play an important role in the implementation and sustainability of SMH services within a school. However, school principals' perspectives regarding their role in SMH implementation are underrepresented in research examining the implementation of SMH services. The present study utilized a semi-structured interview format to examine principals' perceptions of their role regarding the implementation of SMH services in one Midwestern state. Four themes developed: (1) principals perceive SMH services to be beneficial due to increasing mental health needs; (2) principal involvement in SMH implementation varies; (3) critical staff promote SMH; and (4) systemic complexities exist related to SMH implementation and sustainability. Implications for practice, future research, and limitations are discussed.