Identifying youth with mental health concerns and connecting them to effective intervention is important because poor mental health is related to lower educational achievements, substance abuse, violence, compromised health, and reduced life satisfaction. This study examined the ability of teachers (n = 153) to accurately identify mental health concerns among elementary children using vignettes scenarios depicting children with severe and moderate externalizing or internalizing behavior problems. Teachers were asked to rate the seriousness of the problem, their concern for the child’s well-being, and whether they felt the student needed school-based or community mental health services. Findings indicated that teachers can accurately identify students with severe externalizing and internalizing problems. However, they were less accurate and less likely to think students with moderate or subclinical symptoms needed services. Additionally, teachers perceived externalizing problems to be more serious and more concerning, than internalizing problems. In most cases, teachers’ concern for the child’s well-being, but not their perceived seriousness of the problem, predicted endorsement of referral to school and/or community-based mental health professionals, even when controlling for the child’s gender. Implications for practice and future research areas are discussed.