Following a highly publicized murder-suicide by a high school student in Beltrami County, Minnesota, the Minnesota Department of Health initiated an investigation into suicide attempts and self-inflicted harm (SA/SIH) among youths in the county between 2002 and 2006. This article summarizes the results of that effort, which found an annualized rate of 356 hospital-treated SA/SIH per 100,000 population among Beltrami County residents ages 10 to 24 years--a rate more than 50% higher than that of other youths in Minnesota or the United States. In addition, the rate of SA/SIH for American Indian youths in Beltrami County was 2.5 times higher than that for white youths. An examination of medical history found 52% of the youths in this study had previously attempted suicide. This article also discusses several modifiable risk factors that were identified and potential interventions.