This article examines a unique population of undocumented immigrants who have access to healthcare to identify how immigration status hinders mental health service utilization in the absence of barriers related to eligibility and insurance coverage. Little is known about how undocumented immigrants navigate healthcare utilization issues apart from access. The authors conducted semistructured interviews with undocumented students at the University of California campus. The article argues that undocumented immigration status informs mental health-related illness cognitions to negatively affect students’ ability to assess their mental health and need for services. Students expressed low perceived need because they normalized mental strain as a natural product of their unstable immigration status. Many viewed treatment as futile because it could not address underlying immigration-related issues. They also anticipated stigmas associated with mental illness as well as their undocumented status. Solutions to address utilization disparities must go beyond eliminating formal barriers to health access and address such psychosocial barriers, as well as the larger political and social context that produces them.