Background: Studies have established that many depressed adolescent patients do not receive optimal mental health care. Specifically, depression in primary-care settings is underrecognized, undertreated, and stigmatized. Although the seriousness and prevalence of adolescent depression is well known to primary-care physicians, its assessment, diagnosis, and treatment remains a significant problem in general and in rural communities in particular. Aims and discussion: In this article, the author accomplishes three aims: (1) summarizes the most current evidence-based guidelines for depression care for adolescents in primary-care settings, (2) reviews the empirical literature on how key patient demographic variables (race, gender, and age) may be correlated with and predictive of variations in evidence-based depression care (assessment, diagnosis, and treatment) for adolescent patients, particularly in rural areas, and (3) provides implications for translating empirical research findings to evidence-based depression care in rural primary-care settings.