In this article, we focus on pairing instructional approaches with a strong evidence base in math with evidence-based practices for students with extensive support needs. To do so we draw on two sources. We use the 2021 Practice Guide from the Institution for Education Sciences (Fuchs et al., 2021). In addition, we use identified evidence-based practices specific for teaching mathematics to students with extensive support needs (Root et al., 2021; Spooner et al., 2017). We describe considerations for implementation of these practices identified by the IES practice guide by describing how to implement them with learners with ESN using additional evidence-based practices and supports. [This is the online version of an article published in TEACHING Exceptional Children."]