The authors discuss their work with a young adult client who identified as gender fluid. The client was a college student in a rural, mid-south town. The authors are two faculty members who worked with the client for a period of 2 years using a cotherapy supervision approach. The counseling approach was affirmative and person-centered. By keeping a focus on the exploration of gender foremost, the clinicians saw an abatement of other symptoms (depression, suicidality, self-harm, disordered eating, low self-confidence, emotion dysregulation, dissociation, and so on) and an improvement in wellness (relationships, emotion regulation, self-concept, assertiveness, appropriate boundary-setting, and so on) over time. The authors offer specific interventions such as collaborative letter writing and the creation of a transition roadmap. They also highlight the advantages and utility of a collaborative, person-centered, consent-based, affirmative approach to therapy with rural transgender and nonbinary clients with complex presenting concerns.