BACKGROUND Rural young people have high rates of mental illness and low rates of help-seeking making it crucial to extend research about service improvement in rural and remote Australia. OBJECTIVE To describe what rural young people want from their headspace service, and what rural headspace clinicians understand they provide. METHODS This study used a qualitative methodology with reflexive thematic analysis to analyse participant interviews and systematically derive common themes. RESULTS Thirteen participants were interviewed comprising young people aged 16 to 18 years who had accessed one of three rural headspace services, together with clinicians working in those services. Key themes for both young people and clinicians comprised accessibility, flexibility, engagement, safety, youth-focus, and evidence-based treatment although there were some differences of emphasis amongst themes. There was also an additional theme for young people of awareness, and for clinicians of caring. CONCLUSIONS The results supported that what young people were seeking was largely consistent with what headspace clinicians were providing. There were however some specific issues relevant to service provision in a rural context such as increased awareness of services, the need to focus on evidenced based interventions, and better promotion in schools and the local community. Service gaps such as unmet needs for young people with higher risk who might fall outside of agency requirements were also identified. CONCLUSIONS Results of this study help inform better service delivery and increased awareness for mental health of young people in rural communities to improve access and outcomes.