This chapter provides an analysis of rural social work in mental health with a particular focus on anti-oppressive practice. The chapter is written within the Aotearoa New Zealand (ANZ) context and as such addresses cultural dimensions essential to practice with tangata whenua (indigenous peoples of New Zealand). The chapter begins by summarising some key facts about rural ANZ followed by identification of organisational initiatives that have been developed outside of the statutory mental health sector to address health and wellbeing. Discussion about Te Whare Tapa Wha (Durie, 1994) follows, a paradigm for understanding the holistic dimensions of Māori. Next, antecedents for modern day social work are explained noting the dual functions of social justice imperatives alongside, case management. Mental health social work using Larson’s (2008) seven principles of anti-oppressive practice discussed next to demonstrate the implications for rural social work practice in Aotearoa New Zealand. The relevance and application of ecological systems theory to rural social work is alluded to throughout. The chapter concludes with a case study to consider and a list of key points about how to foster effective rural mental health social work in an ongoing way.