Recent statistics indicate that approximately 40% of students enrolled on U.S. college and university campuses report experiencing at least 1 mental health problem in the previous 12 months. Despite the documented benefits of counseling and mental health services on academic performance and degree attainment, only about 10% of mentally and emotionally distressed students ever seek professional help. The purpose of this study, therefore, was to gain a better understanding of why, among college students experiencing similar types of mental and emotional distress, some seek help, whereas most do not. For this study, 2 samples of students were recruited from 1 large, research university campus. The first was a clinical sample and consisted of distressed students who were attending a first screening appointment at the university's counseling center. The second was a random sample of students from the general student population who demonstrated levels of distress similar to the first sample, but who had chosen not to seek professional help. Participants in both samples completed 4 study instruments used for collecting demographic data, as well as data pertaining to help-seeking attitudes, help-seeking behaviors, treatment barriers, types of distress, and levels of distress. Data from both groups were combined to examine what variables contribute to the prediction of who, among similarly distressed college students, chooses to seek professional help and who does not. Of particular interest was the role that treatment barriers related to the affordability, availability, accessibility, and acceptability of mental health services might play in distinguishing help-seekers from non-help-seekers. A binary logistic regression model revealed that treatment-related barriers associated with cost of services, not knowing what services are available, and stigma were found to be significant predictors of help-seeking behavior. Among person-related barriers, measures of depression, generalized anxiety, eating concerns, and substance use were found to be significant predictors of help-seeking behavior. Another person-related barrier, help-seeking attitude, was found to be a significant predictor, but showed a lower rate of accuracy in predicting help-seeking behavior than the other significant predictors. A discussion of these findings is presented, along with associated implications for college campus stakeholders and directions for further research.