Background: The mental health status of students preparing for the National Eligibility-cum-Entrance Test (NEET) in Tamil Nadu is a critical aspect that needs attention. NEET is a highly competitive and demanding examination that serves as the gateway for admission to various medical and dental colleges across the country. The intense academic pressure, coupled with the high stakes associated with NEET, often places a significant burden on the mental well-being of students. The objective of this study was to estimate the prevalence of anxiety, depression, and its contributing factors among students preparing for the NEET exams. Methods: This was a cross-sectional study done among rural students preparing for their NEET exam. Simple random sampling was used to enroll the students with the sample size of 450. Interview was conducted using a questionnaire. Results are presented as frequency and percentage and Chi-square test was done to assess the associated factors. Results: Among the 450 students, the prevalence of anxiety was 53% and the prevalence of depression among rural students was 44%. While comparing gender, family, number of times they appeared for NEET, and their mental health status were statistically significant. Conclusions: Students who prepared for NEET exam had higher level of depression and anxiety. More than one-third of the students had anxiety and more than half of the participants had depression. When students are getting ready for the NEET exam, parents, teachers, students, and the Government should all take the students' mental health status into consideration.