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We review ethnographic methods that allow researchers to assess distress in a culturally sensitive manner. We begin with an overview of standardized biomedical and psychological approaches to assessing distress cross-culturally. We then focus on literature describing the development of reliable and valid culturally sensitive assessment tools that can serve as complements or alternatives to biomedical categories and diagnostic frameworks. The methods we describe are useful in identifying forms of suffering—expressed in culturally salient idioms of distress—that might be misidentified by biomedical classifications. We highlight the utility of a cognitive anthropological theoretical approach for developing measures that attend to local cultural categories of knowledge and experience. Attending to cultural insider perspectives is necessary because expressions of distress, thresholds of tolerance for distress, expectations about stress inherent in life, conceptions of the good life, symptom expression, and modes of help-seeking vary across cultures.