Excessive pressures to excel, generally in affluent contexts, are now listed among the top 4 "high risk" factors for adolescents' mental health, along with exposure to poverty, trauma, and discrimination. Multiple studies of high-achieving school (HAS) cohorts have shown elevated rates of serious symptoms relative to norms, with corroborating evidence from other research using diverse designs. Grounded in theories on resilience and ecological influences in development, a conceptual model is presented here on major risk and protective processes implicated in unrelenting achievement pressures facing HAS youth. These include forces at the macrolevel, including economic and technological changes that have led to the "middle class squeeze," and proximal influences involving the family, peers, schools, and communities. Also considered are potential directions for future interventions, with precautions about some practices that are currently widespread in HAS contexts. In the years ahead, any meaningful reductions in the high distress of HAS youth will require collaborations among all stakeholders, with parents and educators targeting the specific areas that must be prioritized in their own communities. Leaders in higher education and social policy could also help in beginning to curtail this problem, which is truly becoming an epidemic among today's youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).