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Student anxiety is less frequently identified and treated in school settings relative to other mental health concerns (e.g., externalizing behavior problems). Considering the perspectives of school-based mental health providers is critical for improving supports for students with anxiety in schools. The present study examined patterns and predictors of school-based provider perceptions of student anxiety, as well as factors influencing provider self-efficacy when addressing student anxiety concerns. Participants (N = 87) were providers working in a very large school district serving students from highly diverse socioeconomic and racial/ethnic backgrounds. Providers reported on their perceptions of the top-ranking student mental health concerns, as well as their own emotional exhaustion, beliefs about accommodating students who experience anxiety, and perceived self-efficacy responding to student anxiety. 71.3% of providers identified student anxiety within their top five student mental health concerns. Providers in schools with higher proportions of economically disadvantaged students were significantly less likely to consider anxiety a top five concern. On average, providers reported feeling somewhat confident addressing anxiety. Greater emotional exhaustion predicted poorer self-efficacy, whereas prior training in anxiety predicted higher self-efficacy. Beliefs about accommodating anxious students in ways that run counter to anxiety guidelines was not significantly associated with provider self-efficacy. Although anxiety is a well-recognized student mental health concern among school providers, student anxiety is less commonly perceived as a top five concern by providers working with economically disadvantaged students, which may underscore the importance of addressing acute stressors and trauma exposure in such populations. Offering more anxiety-specific training and efforts to reduce emotional exhaustion may improve provider self-efficacy for addressing anxiety. To provide more equitable mental health services and supports for anxiety in school settings, more work is needed to improve identification of student anxiety as well as provider self-efficacy for addressing it within districts serving predominately racial and ethnic minority students.