More than 100,000 Somali refugees have resettled in the United States, creating a need for additional research about mental health needs and premigration experiences that precede resettlement. The purpose of this study was to learn more about premigration traumatic experiences, the process of acculturation following resettlement, and the relationship between premigration trauma, acculturation, and mental health. Eighty Somali refugees from two mid-sized Midwestern cities participated. It was hypothesized that acculturation would mediate the relationship between premigration trauma and mental health symptoms. The results partially supported this hypothesis, dependent upon the dimension of acculturation included in the path analysis. Unexpected relationships among the various acculturation dimensions in the model (American cultural identity, English language competency, and American cultural competency) occurred with traumatic experiences, mental health symptoms, and time in the United States. We discuss implications and directions for future research, practice, advocacy, and training.