The present study compared attitudes toward mental illness among college students in Macao, the United States (U.S.), and Macao students studying in the U.S. A total of 303 undergraduate students participated in the study by completing a self-report survey regarding their perceptions of mental illness. Students in Macao had the most negative attitudes and shame regarding mental illness. Macao students in the U.S. had attitudes intermediate to those of U.S. and Macao students. The findings are generally consistent with the literature and suggest an acculturation effect on the attitudes of Macao students in the U.S.