The National Council of Teachers of Mathematics articulates an ambitious vision of a high-quality mathematics program. Achieving this vision requires competent and knowledgeable teachers who can support all students in learning mathematics concepts with understanding. Effective mathematics teachers are especially needed for high-poverty schools since low-income students score below their peers in all mathematics content areas. This study documents the perceptions of preservice teachers who completed a mathematics practicum experience in an urban elementary school. Problems are identified and suggestions offered by the preservice teachers as they strived to develop into effective mathematics educators at urban high-poverty schools. (Contains 3 tables.)