Despite widespread effects of parental substance use on children, little is known about the experiences of school counselors working with this student population. We examine the experiences of elementary school counselors working with school-aged children affected by parental substance use. Eight school counselors participated in semistructured interviews, which we analyzed using consensual qualitative research. Participants described significant contact with the population in question. Findings suggest that elementary school counselors utilize multitiered interventions but need additional training and job support to meet the prevalent needs of this student population. We provide implications for school counseling practice, research, and counselor training.