If special educators cannot identify pain in students with intellectual disability (ID), students cannot be referred to the school nurse for assessment and management. The purpose of this study was to examine how special educators identify pain in the school setting. Twenty-four special educators participated in focus groups aiming to (1) identify educators' observations and perceptions of pain in students with ID and (2) determine the decision-making processes educators use to determine the need for student presentation or referral to the health office. Overall, special educators know students well enough to differentiate pain-related behaviors from normal well-child behaviors, prioritize student safety, and draw on personal experiences with pain when addressing pain in students with ID. Special educators welcome opportunities to learn more about pain in children with ID. Teachers, nurses, and other professionals should share knowledge about and experiences of working with students in pain to improve practices.