The adequate preparation of future teachers of mathematics is critical, requiring sufficient opportunities to develop both pedagogical skill and content knowledge. Yet, despite new recommendations for mathematics teacher preparation, we know little about the landscape of course-based learning opportunities in US elementary teacher education programs. To what extent do US elementary teacher education programs meet the "Standards for Preparing Teachers of Mathematics" outlined by the Association of Mathematics Teacher Educators (AMTE) for mathematics content and methods courses? Based on an a priori power analysis, we gathered a random sample of 291 higher education institutions. Within these institutions, we analyzed 736 programs, including Bachelor's, Master's, and Credential programs. We found that overwhelmingly US elementary teacher education programs do not meet the aspirations outlined in the AMTE standards, with Master's and Credential programs and those covering all elementary grades particularly falling short. Potential explanations for these challenges and implications for teacher education program design are discussed.