The implementation of multitiered systems of support (MTSS) provides an opportunity for schools to screen, monitor progress, and offer research-based instructional and behavioral supports with increasing intensity to students to meet their educational and behavioral needs. MTSS is increasingly being used as a framework for supporting the needs of all learners through strong core instruction while simultaneously allowing for supplementary supports for some students as needed. However, despite the increasing prevalence of MTSS, students with disabilities continue to experience persistently poor academic and behavioral outcomes (Danielson & Rosenquist, 2014). Research also shows that 3-5% of the general school population does not respond to the core and supplementary interventions that are typically delivered through MTSS (D. Fuchs, Fuchs, & Compton, 2012; Wanzek & Vaughn, 2009). These students are those who exhibit the most severe and persistent learning and behavioral needs and who require intensive intervention. Although most components of MTSS require additional development (L.S. Fuchs & Vaughn, 2012; Gersten & Dimino, 2006), intensive intervention may be the component least well developed. Given their specialized expertise, special education administrators are in a unique position to provide needed guidance and leadership in districts and schools struggling to educate their students with the most intensive learning and behavioral needs. This paper reports findings from a study conducted to describe how districts, identified as high performing with respect to the academic outcomes of students with disabilities, define and implement intensive intervention. The authors selected five sites (Alton, IL; Hancock, WV; Jenison, MI; Okaloosa, FL; and Scituate, MA) from a pool of districts after applying two methods: (1) a statistical analysis of district-level academic achievement data for students with disabilities; and (2) nominations. Findings from site visits, interviews, and district data revealed that intensive intervention is a component of a multitiered system of support; instructional decisions rely on assessment and progress monitoring data; family engagement is challenging but valued; capacity building integrates intensive intervention; intensive intervention typically involves adaptations of tier two interventions; and fidelity is inconsistently monitored.