Background: Recess provides an important opportunity for children to be physically active during weekdays. Updated, nationally representative, prevalence estimates of elementary school recess practices in the United States are needed. Methods: Surveys were sent to a nationally representative sample of 1010 public elementary schools in the 2019-2020 school year. Results were compared by region (Northeast, Midwest, South, West), urbanicity, size, racial and ethnic composition, and socioeconomic status (percent eligible for free/reduced-priced meals). Results: A total of 559 responses were obtained. About 87.9% of schools provided at least 20 minutes of daily recess and 26.6% had trained recess supervisors. Most schools did not allow students to voluntarily stay inside during recess (71.6%) and around half prohibited withholding recess for poor behavior (45.6%) or to complete schoolwork (49.5%). Several practices varied by region, and withholding recess was more prevalent among schools with lower student socioeconomic makeup. Implications for School Health Policy, Practice, and Equity: Regular national surveillance of recess practices can inform policy needs and efforts to advance equitable access to recess. Quality and access should be considered when developing recess policies. Conclusions: Most United States elementary schools provide recess. However, regional and economic disparities exist. Promoting supportive practices for recess, particularly for schools serving lower-income communities, is necessary.