Background: Despite a clear need for mental health services in rural Bangladesh, there is limited access and provision, especially in areas vulnerable to the effects of climate change. Community health workers (CHWs) are commonplace in rural communities and their health services promise to be more culturally sensitive, pragmatic and actionable. Methods: We conducted an exploratory qualitative study using in-depth interviews with 16 community health workers (CHWs) trained in basic mental health support. These are the only providers of such care in rural Bangladesh. Using reflexive thematic analysis, we explored how CHWs introduced the stigmatized topic of mental health and balanced local beliefs with their basic training. Results: The training shifted CHWs’ perceptions of mental health, and they adopted strategies to reduce stigma and build trust, such as using culturally appropriate language and rapport-building techniques. Their understanding of community norms allowed them to act as bridges between local and professional mental health perspectives. Conclusions: CHWs shape and redefine the service they deliver through their unique positioning, which forms interventions to be more context-relevant and appropriate. We recommend strengthening the services CHWs’ provide through continued training, material support, and formal recognition.