Project DREAM seeks to build a strong partnership among people with lived experiences, direct service providers, and researchers in order to improve mental health in rural areas. We are united in a common dissatisfaction with the delivery and outcomes of mental health care, especially for individuals contending with the dual challenges of mental illness and poverty. Patient and stakeholder partners articulated their needs, challenges, and priorities in Tier I, noting feelings of disconnection between patients and healthcare providers, being frustrated by fragmented systems of care, and not having services that attended to “what really matters.” In Tier II, our partnership seeks to build on these patient-centered concerns to focus on four areas of interest: peer-based services, service coordination, clinical communication/patient activation, and supported employment. We will build on our strong existing partnership to engage new partners across the patient, stakeholder, and research communities to deepen our knowledge base in these areas. We will work collaboratively to develop viable patient-centered research questions to improve the mental health of rural marginalized populations.