Purpose: This exploratory study examines the intersection of teletherapy and multi-tiered system of support (MTSS) in school-based speech-language services and explores ways in which the challenges related to MTSS vary by service delivery modality. Method: This study involved 10 interviews with five speech-language pathologists (SLPs) who have had experience in both in-person and teletherapy-based positions and were working for the same educational agency as teletherapists during the 2023-2024 school year. Qualitative data were collected about unique facilitators and barriers teletherapists face concerning MTSS and how the defining features of teletherapy (e.g., technology and on-site facilitation with a remote SLP) impact their engagement with MTSS in both helpful and constraining ways. Results: Participants, all of whom worked remotely with students attending schools in person, identified a number of opportunities and challenges related to engagement with MTSS. Some challenges were identified as common to both face-to-face and remote work (e.g., misunderstandings related to the role of SLPs in MTSS). Others were unique to teletherapy in ways that made implementation easier (e.g., intentionally planned and focused conversations) as well as harder (e.g., lack of visibility and spontaneity). There were pros and cons of how technology and on-site facilitation impacted MTSS implementation. Conclusion: As teletherapy and prevention-oriented work gain prominence in the postpandemic reality, this study offers initial insights into the synergies and challenges of engaging with the MTSS as a school-based teletherapist.