The field of special education's focus on moderate and severe disabilities (MSD) has undergone a number of changes in the past five decades. Some have been philosophical, some based on research, some based on mandated practices through U.S. law, and some based on the development of better technologies. While pioneers in the field first established the basic principles on which an appropriate education for students with MSD is based, subsequent scholars and professional organizations have determined how those principles are best implemented. As rural special educators involved in the field since the 1970s, we provide a reflection on the barriers and challenges faced by rural special education teachers as they continue to address the needs of rural students with MSD and make suggestions for current and future practices.