Many students with extensive support needs (ESN) benefit from specific instruction as well as a range of communication supports to develop effective communication repertoires and fully participate in their educational experience. Although evidence-based practices and supports addressing the communication needs of students with ESN have been identified, there remain concerns about whether preservice special education teachers have been adequately prepared to implement them. The purpose of this study was to explore the perceptions of preservice special education teachers related to their preparation in communication instruction for students with ESN. Participants reported varying levels of preparedness and a range of experiences in terms of the quantity and content of coursework and opportunities to apply knowledge and skills within their programs. We present implications for future research directions and teacher preparation programs.