The ability to use written language to communicate receptively (i.e., reading) and expressively (i.e., writing) is important in school, work, and independent living. Students who struggle early with reading have difficulty catching up with their peers as they move through school and in academic areas that rely on reading proficiency. Individuals with disabilities who are unable to effectively and efficiently use oral speech may benefit from augmentative and alternative communication (AAC) to facilitate early literacy development. AAC includes all of the ways students share their ideas and feelings without speaking. Because individuals with disabilities who use AAC may rely on reading and writing skills for expressive communication, instruction in reading and writing is particularly important. Prior research indicated that, in the past, AAC users were taught to read through memorization of sight words, however relying solely on sight-word instruction put students who used AAC at a disadvantage because they did not develop decoding strategies for approaching new words. When students who use AAC are taught to read, they need to receive systematic instruction in the range of skills that contribute to word-level reading. A great deal of early literacy instruction that leads to word-level decoding relies heavily on oral speech, therefore, teachers may experience unique challenges when designing and implementing interventions to support the acquisition of these skills for students with physical disabilities and complex communication needs (PDCCN) who use AAC. This article discusses techniques and strategies that literacy instruction teachers can use to benefit students with PDCCN who use AAC. Creating meaningful early literacy instruction requires teachers to engage in modified assessment procedures, determine students' response modes, ensure that AAC systems facilitate instruction, and systematically plan for instructional opportunities. Tables provide useful guidelines for Beginning Literacy Instruction, and Standard Assessment Practices and AAC Adaptations for Beginning Reading Skills.