Students with mathematics difficulties and disabilities require evidence-based instructional strategies and interventions to improve their mathematical performance. Dissemination of these practices to teachers in rural settings presents specific challenges, including lack of Internet access, few discretionary resources, and geographic isolation. This mixed-method study explored rural Texas teachers' perceptions of their algebra content knowledge; their comfort with strategies, interventions, and resources; and professional development experiences related to students with mathematics difficulties and disabilities. Findings suggest that teachers are unfamiliar with or do not regularly implement evidence-based strategies and report regular use of strategies such as learning styles that have a limited evidence base. A discussion of findings includes suggestions for professional development tailored to the needs of rural Texas algebra teachers.