Context: There is limited evidence on the extent of the perceived need for professional mental health care and barriers to the delivery of mental distress services among university students in low and middle-income countries. Objective: The current study was designed to assess the prevalence of mental distress, perceived need for professional mental health care and barriers to the delivery of the service for regular undergraduate university students. Methods: A multi-stage sampling technique was used to recruit 1135 regular undergraduate university students. Symptoms of mental distress were evaluated using the Self-Reported Questionnaire (SRQ-20) and a score of eight and above was used to identify positive cases. The perceived need for professional mental health care was assessed using one question with binary responses, whereas barriers to mental health care were assessed using Barriers to Access to Care Evaluation (BACE-30) tool. The association of demographic variables with total mean scores of BACE-III sub-scales was modeled using multiple linear regression. Results: The prevalence of mental distress symptoms was 34.6% and the perceived need for professional mental health care was 70.5%. The top five barriers to receiving professional mental health service were (a) thinking the problem would get better by itself, (b) being unsure where to go to get professional care, (c) wanting to solve the problem by own, (d) denying mental health problem, and (e) preferring to get alternative forms of mental care. Conclusions: The high prevalence of mental distress, mental health care gap, and the report of barriers to professional mental health care among Ethiopian regular undergraduate students is a call for action. Keywords: Mental distress, Perceived need, Barrier, and Professional mental health care.