Sexual and gender minority (SGM) youth are at disproportionate risk for HIV. Schools play an integral role in educating young people about sexual health in addition to providing sexual health services. This qualitative study examined SGM youths’ perception of school sexual health education and services. A total of 42 self-identified African American SGM males participated in focus groups or in an in-depth interview. Qualitative findings revealed that schools are missing the opportunity to educate SGM youth about sexual health. Youth participants noted several barriers to accessing sexual health education and services at schools including limited, targeted health information and school nurses not being knowledgeable of health issues that impact SGM youth. Participants noted that school sexual health services are not adequately marketed to students and sometimes do not include testing for HIV and other sexually transmitted diseases. Suggestions for future research and implications for school nurses and sexual health services are discussed.