Lesbian, gay, bisexual, transgender, questioning/queer, and other gender diverse (LGBTQ+) adolescents face daunting hardships within the rural contexts they navigate (e.g., community, school), and these onerous demands make it difficult for them to maintain optimal mental well-being. This scoping review described the psychosocial protective and risk factors that shape mental well-being for rural LGBTQ+ adolescents and identified the mental health issues commonly reported by them. About 30 articles published between 2005 and 2020 were examined. A myriad of factors indicated protection of or risks to LGBTQ+ rural adolescents’ mental well-being through the social-ecological levels: individual (e.g., pressure to conform to gender norms, sexual exploration, coming out), interpersonal (e.g., connectedness, fear of rejection, religious beliefs), institutional/school (e.g., bullying victimization, social exclusion, peer/teacher intervention), and rural community (e.g., community size, local ties, social isolation). More research is needed to better understand and address rural mental health disparities for this vulnerable group.