Background: There is a need to understand how schools adopt physical activity approaches (curricula, programs and practices), but few studies report on this process. Purpose: To obtain elementary school staff's perspectives regarding how their schools are currently adopting physical activity approaches. Methods: We recruited 15 participants from four job types in an urban Texas school district to participate in semi-structured interviews. We coded and analyzed interviews using directed content analysis and iterative categorization. Results: We identified four themes pertaining to how the district, schools, and teachers contribute to the adoption of approaches. Themes included: (1) Staff identify new approaches through numerous channels; (2) Adoption occurs at multiple organizational levels; (3) District staff fulfilled a supporting role in the adoption process; and (4) School staff's perceptions of approach characteristics influence adoption. Discussion: We found that schools adopt physical activity approaches at both the district- and school-level. Additionally, multiple stakeholders played a role in the adoption process and those roles varied across approaches. Translation to Health Education Practice: Time, money, space, staff, competing priorities, limited information, the school's mission, and the benefits an approach provides to children are factors that researchers and practitioners should consider when starting a new physical activity approach.