Accurate identification of autism is a pressing challenge for rural, medically underserved communities. Tele-assessment could address some barriers to care by increasing access to expert diagnosticians, but questions remain regarding how best to implement these approaches. To gather community input regarding rural families' perceptions and use of tele-assessment for autism identification, we conducted four focus groups with caregivers of children with autism (n = 22) and community service providers (n = 10) living and working in rural areas in the Southeast region of the United States. An iterative inductive/deductive approach guided qualitative data analysis. Coding reflected four core attitudes central to community perceptions, including (1) questions surrounding the validity (scientific legitimacy) of tele-mediated autism assessment; (2) level of trust in the evaluation process in general (and tele-assessment specifically); (3) beliefs about the feasibility of tele-assessment; and (4) concerns related to privacy. These attitudes and beliefs are influenced by determinants at multiple levels and stages, highlighting the need to adapt the existing tele-assessment approach by embedding implementation strategies that support multiple actors at each stage. This work identifies important targets for ensuring equitable access to tele-assessment for rural families.