This multi-case qualitative study describes how leadership coaches working in a university-based coaching program provided support to school principals in three urban elementary schools in the western United States. Drawing on qualitative data collected during a single school year, the study examines which issues leadership coaches prioritized and how they provided coaching support. A thematic analysis of the data produced four findings. These findings suggest that coaches focused their work on classroom instruction and adopted differentiated responses to support based on principal and school needs. The article concludes by discussing the implications for leadership preparation and school reform.