This paper documents the perceptions and experiences of faculty members in the midst of statewide reform efforts in Virginia and North Carolina to integrate developmental reading and writing courses. Using interview and focus group data from 161 faculty and administrators in both states (combined) as well as three detailed case studies of faculty teaching newly integrated courses, we describe how departments and faculty approached the task of course integration. Findings suggest that while instructors had a generally positive impression of integrating the two disciplines, implementing these new courses was not without challenges. A common approach to course design, which we term "additive," involved combining assignments and activities from the old standalone courses. We identify a range of factors associated with using the additive approach, including conceptions of literacy learning focused on the mastery of discrete skills, professional development aimed at exchanging activities and materials between reading and writing instructors, and lack of a clear framework for an integrated course design. Instructors using the additive approach reported that they could not cover all of the content/activities from the previous courses under the accelerated course structure, and worried they that they were not able to provide students the literacy skills they needed to be successful in college. Yet some faculty used or began to adopt what we call an "integrative" approach to course design in which few standalone components of the previously offered courses remained. Integrative course design tended to emphasize metacognition, extensive text-based writing, and embedded skills and strategy instruction, often offered in a "just-in-time" fashion. Faculty perceived that these more "integrative" course elements were associated with improved literacy learning. The findings presented have implications for creating support resources and professional development for departments and faculty who are new to teaching integrated reading and writing courses. The paper includes several curricular examples which can be adapted and used by faculty teaching integrated developmental courses.