The modern university presidency continues to become more complex, resulting in numerous personal and professional stresses placed on a president. This study explores the sources, impacts, and successful prevention and management of stress in the position. Data for the study comes from qualitative phenomenological interviews with five sitting presidents of public and private universities in the United States. Using a theoretical lens derived from executive stress theory, the authors examine the degree to which a need for personal control and stability play a role in producing stress and motivating certain stress responses. Meaningful relationships, positive mindsets, and repeatable practices of self-care and reflection are found to have a positive impact on presidents' ability to manage stress. Greater awareness of stress management through education and training will benefit presidents and prospective presidents in navigating the position.