In April 2005, during a studio recording session, producer Christopher Stevens was playing chords they had planned for the track.

[2] "[We] went over it and ended up with 'I'm Not Alright', which was a true confession of how we were feeling and gave us a little of the freedom and emotional release to be honest and vulnerable.

According to a Christianity Today music review, the song "comfortably [rests] somewhere between Switchfoot's "Meant to Live" and Coldplay's "Fix You".

[4] The song was released on February 21, 2006 as the lead single from Sanctus Real's album The Face of Love,[5] and went on to reach number 1 on Christian radio that year.

The video was featured on MTV's mtvU competition in July and was eventually voted in by viewers as the winner among three other contestants.