Context: Leadership skills are important for all athletic trainers whether or not they hold formal leadership positions. Active engagement by members within professional associations can enhance individuals' leadership skills and aid the growth of the profession. Objective: Understand common factors in and barriers to athletic trainers' involvement in leadership positions within their state's athletic training association. Design: Qualitative -- Grounded theory. Setting: Zoom interview. Patients or Other Participants: A purposeful sampling was performed. Inclusion criteria were met if participants were certified for 5+ years and currently serving on the executive board of their state athletic training association. Fifteen athletic trainers (age = 42.7 ± 7.8 years), predominantly men (73%), were included in this study. Data saturation guided the total number of participants selected. Data Collection and Analysis: Semistructured interviews were performed using Zoom and transcribed verbatim. Data were analyzed using inductive content analysis. Transcripts were coded and grouped by themes and subthemes. To maintain trustworthiness, peer review and member checks were performed. Results: Participants were primarily motivated to seek out leadership opportunities in their state association to get involved within the profession. They also received encouragement from influential individuals who helped the participants see their abilities to impact others. The main barrier participants identified was fear. Fear encompassed many aspects, including ambiguity surrounding their role, as they were unsure of their full responsibilities or how to perform the role successfully. Other barriers included time commitment and self-doubt. Conclusions: Participants' desire to get involved and the encouragement they received helped to increase confidence in their abilities to lead and contributed to their involvement in their state association. By encouraging colleagues, coworkers, and mentees to get involved, as well as by athletic training associations implementing a transition period for newly elected leaders to learn their responsibilities, many barriers athletic trainers identified can be reduced.