This study aims to identify which factors predict psychological distress among international college students attending American universities. International students experience unique stressors, as well as bring with them their own enculturation: culture of origin identity, language, and competence when acculturating. To get a comprehensive picture, we collected survey data on demographics, acculturation, stress, anxiety, depression, and symptomatology from N = 146 college students (n = 51 international students; n = 95 U.S. citizens) from three universities in the southeastern United States. For international students, increased acculturation to the U.S. (English proficiency and culture competence) is related to decreased symptomatology and anxiety. Additionally, international students' competencies in culture of origin are significantly associated with competencies in U.S. acculturation. Regression analyses indicated that among international students, higher U.S. acculturation and lower stress, significantly predicted less anxiety; lower stress significantly predicted less symptomatology. Implications for higher education and future research are discussed.