All teacher preparation programs face serious challenges; however, programs that prepare teachers to work with students with extensive support needs face additional, unique challenges in preparing professionals to facilitate their students' development of functional skills and to ensure their access to the general education curriculum. The purpose of this article is to examine current issues in preparing teachers to work with students with extensive support needs. An examination of how philosophy, law, research, and certification requirements impact the content and structure of teacher preparation programs is provided. Suggestions for teacher educators are included.