In Sweden, a lack of accessible specialist mental health services places the sole responsibility for caring for people with mental ill-health in rural areas on primary care. Caring for people with severe mental ill-health can pose challenges for district nurses in rural areas. The aim of this study is to describe district nurse’s experiences of encountering people with mental ill-health in rural primary care. Semi-structured interviews were conducted with nine district nurses working in primary care in rural areas in Northern Sweden. Interviews were analyzed with qualitative content analysis. The results describe district nurses’ experiences of encountering people with mental ill-health as a strive for a good relationship. They wanted to understand the core of patients’ needs and adjust their approach based on that. However, organizational obstacles and opportunities affected these encounters, particularly the lack of time and the importance of continuity. Being a primary care nurse in a rural setting provides specific challenges and opportunities when caring for people with mental ill health. District nurses would benefit from organizational support in establishing and maintaining good relationships as a foundation for quality care. Providing district nurses with greater autonomy over their time, along with enhanced support and access to resources would acknowledge and reinforce the critical professional role they play in rural healthcare delivery.