English medium instruction (EMI) is a growing phenomenon in many countries. Some researchers have investigated the difficulties and strategies students use to cope with EMI. However, the pedagogical challenges faced and strategies used by other key participants, teachers, have been surprisingly under-researched. This study utilizes questionnaire and interview data to identify the challenges and coping strategies used by secondary school EMI science teachers in Hong Kong. A number of challenges and strategies were reported. The authors argue that many of these challenges can be overcome with principles and strategies from ELT, as the 'English' in EMI is often the main issue. The most prevalent strategy reported is the use of L1. Two perspectives on L1 usage in EMI contexts are discussed. Two emergent realities are presented as possible solutions: the idealized reality and the immediate reality. Implications for teachers and suggestions for future research are provided.