Professional sensitivity to cultural issues during augmentative and alternative communication (AAC) design and implementation has gained increasing attention in the professional literature. This article describes four cultural domains in which core values characteristic of Native American tribes are discernable: spirituality, trustworthiness, family, and communicative variables. Implications of AAC for practitioners are noted in each of these domains, followed by a description of the results of an ethnographic study investigating the real experience of implementing AAC for two Native American students, their families, and their educational teams. Field observations; videotapes of use of voice output communication aids; and interviews with AAC users, their family members, and educational teams provide data for examination. These data support a grounded theory describing the experience of Native American AAC users who are still missing a key element related to Native American culture. (Contains 1 table and 1 figure.)