ABSTRACT Due to high‐stress agricultural working environments, farmers are at high risk for mental illness, including anxiety, depression, and suicide. These challenges are exacerbated by rural settings with limited access to mental healthcare and pervasive mental health stigma. An area of increasing interest is how climate change impacts, such as drought, extreme temperatures, and changing seasons, impact farmer mental health and well‐being. Utilizing a mixed‐methods approach, we analyze pathways through which extreme weather may adversely affect farmers' mental health, emphasizing the impact of extreme weather on stress and distress in the U.S. Midwest. Our narrative synthesis of existing literature reveals several pathways linking the impacts of climate change to negative mental health outcomes for farmers, including exposure to chronic stress, the uncertainty and lack of control associated with extreme weather, and the erosion of place and “good farmer” identities. Quantitative analysis of survey data from 837 randomly sampled farmers in Ohio, USA, was used to test findings from our narrative literature review. Results showed a significant association between exposure to extreme weather events and heightened comprehensive stress and psychological distress. More empirical work is needed to test the pathways through which extreme weather may impact farmer mental health and well‐being.