This study explored the effects of high-stakes testing and accountability on the fundamental practices associated with middle school philosophy. Participants were middle school educators, including administrators and teachers, from Pennsylvania middle schools. An online survey was used to collect data for this study. The survey addressed the following middle school practices: grouping for instruction, developmentally appropriate instructional practices, interdisciplinary and integrated curriculum, interdisciplinary teaming and planning, and advisory programs. Participants were also encouraged to add comments throughout the survey. Findings revealed that since the implementation of No Child Left Behind (NCLB) and the associated high-stakes tests, developmentally appropriate practices in middle schools have been altered to provide additional time for test preparation. In many cases, tested subject areas (specifically reading, writing, and mathematics) were given more instructional time during the school day. Furthermore, special area subjects (i.e., electives) were often sacrificed and, in some cases, advisory time was used for remediation. Implications for practice focus on the need to maintain a balance between test preparation and practices deemed appropriate for middle school students. (Contains 8 tables.)