This study examined the relationship of stress, burnout, and coping strategies among middle school principals in Western Pennsylvania. This study assessed coping skill preferences among middle school principals, especially regarding their age, gender, marital status, experience, and school enrollment. A review of the literature included studies regarding moderate to high levels of stress and the principal. Researchers indicated that the middle school principal's job is very stressful due to the scope of responsibilities at that level (Cusack, 1982; Fogelson, 1992; Foster, 1986; Heinze, 1987; Saffer, 1984; Thompson, 1985). Studies of principals support the proposition that specific stress levels can affect these individuals. This study confirms the kinds of stress middle school principals face and to some extent, how they prefer to cope with it. The work world of principals has expanded in both complexity and quantity. Principals are spending more time on the job than they had in the past, and they are navigating ways to be successful in the high stakes work context that has permeated the job. This changing nature of the principalship has required more time, political savvy, stress, accountability measures, legal expertise, and the ability to deal with health concerns. This particular theme is not well researched in school leadership. The intent of this study was a step on the way to developing a framework for the type of work that is done by middle school principals in Western Pennsylvania, while also reviewing the physical and emotional costs that are derived from the competitive nature of increased accountability along with the myriad of responsibilities faced by these school leaders. The purpose was also to measure the direct and indirect effects of job characteristics, interpersonal relationships, role stress, psychological states, and task outcomes on middle level principals. Data were collected by an online questionnaire and followed by semi-structured interviews by volunteer participants. Data were analyzed throughout the study to guide decisions and determine emergent themes. By studying the phenomenon of work demands on principals in the 21st Century, the educational community gains insight into the functional work-related behaviors of leaders and their level of job satisfaction. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]