Background: Migrants from countries in the Northern Triangle made up 92% of attempted crossings on the United States Southern international border in 2021; Guatemala is the top sending country in that region. Scholarship in Guatemala has focused on escape from violence and economic opportunity as reasons for migration; however, drivers of migration are more complex, including “aspirations” of transnational families and influences of social networks. Furthermore, few studies have addressed the mental health distress caused by being “left-behind” to migration in Guatemala. Social network characteristics may moderate some mental health impacts of migration, but this has not been investigated using socio-centric network data from Central American migrant-sending communities. Methods: This dissertation includes three studies undertaken in partnership with participants using CBPR. Study 1 leverages data from focus groups and Photovoice interviews to investigate perceived changes from migration impacting community health. Qualitative results informed the research questions in studies 2 and 3. Studies 2 and 3 use data from a census of a representative community in the region. Study 2 evaluates the demographics, social network characteristics, and network dynamics influencing migration decisions. In study 3, we evaluate the relationship between migration and depressive symptoms, and the social network characteristics that may moderate that relationship. Results: Migration impacts rural communities in Guatemala in several ways, including mental health distress among those left-behind (Study 1). Twenty-two percent of the population had plans to migrate. Having a child emigrate reduced the odds of migration (OR 0.08). A spouse remaining was predictive of migration (OR 2.38) (Study 2). Having emigrant ties in the US increased the odds of depression (OR 1.11), as did a higher out-degree. Higher transitivity scores, especially for women, moderated the relationship between migrant ties and depression (Study 3). Conclusions: Migration changes social structures in rural Guatemalan communities, resulting in feelings of sadness and loss. Social network characteristics influence migration decisions among transnational families. Migration from the region is not slowing, so understanding the mental health impacts in migrant-sending communities is imperative. Social network characteristics should be explored in further research as potential assets to ease mental health burdens among those left-behind.