We examined the effects of integrated cognitive-behavioral therapy for depression and insomnia (CBT-D + CBT-I, respectively) delivered via videoconference in rural middle-aged and older adults. Forty patients with depressive and insomnia symptoms were randomized to receive either 10 sessions of CBT-D + CBT-I or usual care (UC). Patients in the integrated CBT condition were engaged in telehealth treatment through Skype at their primary care clinic. Assessments were conducted at baseline, posttreatment, and 3-month follow-up. CBT-D + CBT-I participants had significantly greater improvements in sleep at posttreatment and 3-month follow-up as compared with the UC participants. The Time + Group interaction for depression was not significant; participants in both the CBT-D + CBT-I and UC conditions showed a decrease in depressive symptoms over time. Although integrated CBT benefits both depression and insomnia symptoms, its effects on depression are more equivocal. Further research should consider expanding the depression treatment component of integrated CBT to enhance effectiveness.