Individuals from Asian American (AA) and international Asian (IA) backgrounds are often lumped together in mental health research, which may obscure important differences in mental health presentation and need. While previous research has examined differences amongst AA and IA students seeking therapy at a single university counseling center, our study sought to better generalize these findings by utilizing a national data set to examine differences in treatment utilization, presenting concerns, overall distress, and improvement in treatment. Our results showed that IA students utilize therapy at lower rates than AA students. However, both groups attended appointments at roughly the same rate. Distress at intake was significantly higher for IA students across most domains measured. Finally, both groups improved in treatment at similar rates, with some differences observed between IA undergraduate and graduate students. We discuss implications for college counseling professionals and urge further research in this domain.