This study identifies factors that affect school refusal among preschool children in public schools of an Appalachian state. School refusal is defined as behavior through which children refuse school by active protest, inactive protest, or denial. A random sample of 198 preschool teachers representing 6,309 children provided the data for the study. Teachers completed three short questionnaires concerning both the school and the child's school refusal behavior over three time periods. Results show that 15.6% of the children manifested the symptoms of school refusal. Some findings were: (1) school refusers were more likely to be boys; (2) more than one third were youngest children; (3) fewer children who lived less than two miles from the school and who had had prior preschool experience exhibited refusal; and (4) fewer refusals occurred in part-day sessions and sessions held on consecutive days where parents were included and the teacher was experienced in early childhood education. The following categories describe the events preceding refusal behavior: (1) school regulations; (2) separation from friend or sibling; (3) bus fears; (4) academic demands; (5) new experiences or people; and (6) fear of gym or gym teacher. Seven patterns of refusal were identified, based on the time periods of the refusal. Recommendations for preventing school refusal deal with intake procedures, structure of the sessions, experience of the teachers, developmental needs of students, parental participation, and bus practices. The survey instruments are attached. (KS)