The problem addressed in this study was that teachers are struggling to support the instructional needs of at-risk students Grades 3-5 in mathematics in a Southern state. The purpose of this basic qualitative study was to explore the perspectives of Grades 3-5 teachers of the instructional supports, approaches, and recommendations to support the mathematics achievement of at-risk students in Grades 3-5. Bruner's theory on the stages of representation informed this study. The research questions focused on Elementary teachers' perspectives and recommendations of instructional supports and approaches to support the mathematics achievement of at-risk students in Grades 3-5. Data were collected via semistructured interviews with 10 participants who met the criteria of (a) being certified educators with experience teaching mathematics in Grades 3-5, (b) having experience teaching mathematics to students who failed to meet the state mathematics proficiency assessment, and (c) having experience teaching mathematics to at-risk student populations. Data analysis involved using a Priori and open coding to identify codes, categories, and themes. The emergent themes were (a) using varied instructional approaches, strategies, and grouping, (b) knowing the student, and involving parents, (c) struggling with class size, supports, resources, and professional development, (PD), and (d) recommending additional resources including funding, time, staff, and professional development. The findings may inform stakeholders about the needs of Elementary teachers in the study state. The findings may inform stakeholders about the needs of Elementary teachers in the study state. With this knowledge, stakeholders may be able to provide the needed supports, resources and PD to strengthen mathematics instruction thereby potentially promoting student achievement and positive social change. [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.]