This randomized repeated-measured active control group study examined the efficacy of child–teacher relationship training (CTRT) as a mental health intervention in rural Head Start programs with at-risk children. Experimental group child participants demonstrated statistically significant decreases in total problem behaviors when compared with active control group children. All child participants exhibited improvements in targeted behaviors with small-to-moderate treatment effects. The findings indicate that CTRT positively influences children’s problem behaviors with implications for rural mental health interventions. (author abstract)