The project purpose was to assess risk factors for evaluating suicidality in the rural population. There was an increase in completed suicides from 2011 to 2014 compared to 2015 and 2016 in one rural county. Associated risk factors combined with suicidal behaviors were identified as significant mental health concerns among providers and law enforcement. The root cause analysis framework was used to guide the review of the two completed suicides and interviews with providers and law enforcement personnel to examine risk factors. The interview questions and rural suicide assessment risk tool (RSART) were developed from several sources identified in the paper. The RSART was introduced to assist healthcare providers and law enforcement person to screen and evaluate individuals for suicidal risk. The findings support incorporation of the RSART for screening and evaluating individuals for risk factors to improve detection and intervention. Keywords: rural mental health, suicide risk formulation, adults