This article presents the findings from a national study on the experiences of educators with gay, lesbian, bisexual, transgender, and queer (LGBTQ) topics in elementary schools and recommendations for practice based in our experiences as classroom teachers and teacher educators. Using responses to open-ended questions that were part of a large-scale survey, we discuss the ways LGBTQ content is being included in PK-5 classrooms and the challenges and supports teachers experienced when introducing LGBTQ-related content or engaging in other visibility efforts and activities. These findings are placed in conversation with our experiences supporting educators preparing to do this work and inform our recommendations for practice. The importance of developing confidence and knowledge about gender and sexual diversity topics to address fear-based reasons for not engaging in this work are discussed, as well as ways to address these challenges for elementary educators.