There were concerns in both quantity and quality of principal candidates regarding training experiences and principals being prepared to lead schools. Research was limited when it came to principal preparation programs (PPPs) training rural, East Tennessee school principals to become instructional leaders and school district leaders providing ongoing professional development opportunities for rural principals. Due to the overall lack of research regarding these facets, further research was necessary to understand how PPPs advisors and school district leaders needed to better prepare rural school principals to lead instructionally. Twenty rural school principals responded to a questionnaire regarding principals' perceptions of PPPs and ongoing professional development opportunities. In addition, I interviewed five rural school principals to investigate their beliefs based on Bandura's (1977) self-efficacy theory regarding performance accomplishments. The purpose of this qualitative, interpretive study was to understand the perceptions of rural, East Tennessee K-12 school principals and how principal preparation programs and ongoing professional development opportunities prepared them to be instructional leaders based on Bandura's theory of self-efficacy regarding performance accomplishments. After analyzing the data, I found rural, East Tennessee K-12 school principals were prepared most to be instructional leaders when coursework focused on practical, real-life experiences and ongoing professional development opportunities were specific to individual school districts' needs. This was a foundational study as it could be used as the framework for future studies exploring PPPs and how to better prepare rural school principals to succeed in East Tennessee as instructional leaders. [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.]