International students have unique mental health challenges compared to their domestic student peers in adjusting to college life in the United States. Delivering culturally competent and socially just on-campus counseling services is a critical task for mental health professionals at university counseling centers. The purpose of this article is to review the existing literature on international students’ college adjustment in the U.S. and provide guidance for counseling international college students in the U.S. We address criticalities for understanding and investigating the international student population, in addition to describing considerations for individual and contextual factors pertinent to international students’ adjustment to U.S. college life. We conclude by describing the best practices for counseling international college students.