A survey was conducted with 86 teachers across 10 states regarding their students' ease of use of physical manipulatives incorporated with implementing evidence-based early numeracy instruction. The majority of respondents indicated significant student accessibility barriers. Specifically, 75% of respondents had students with tactile defensiveness or lack of gross motor skills; 85% had students with weak to no fine motor skills; and 83% had students who lost track of the math objectives while manipulating materials, making the use of manipulatives difficult or impossible. Ninety-four percent of respondents agreed or strongly agreed that the use of manipulatives are valuable for students to gain early numeracy concepts; however almost half indicated difficulty using them within math instruction. Finally, respondents overwhelmingly noted their student engagement with technology (e.g., iPad, Smart Board) to support learning. Overall, survey results and the need for future research, including the use of virtual manipulatives, are discussed.