The purpose of this article is to examine how the relationship between comprehensive school reform (CSR) and state accountability systems helps or hinders school improvement efforts. This article draws on case study data collected in schools in 3 states that received funding to implement reforms through the federal CSR program. Findings show that the 3 states all had high-stakes accountability systems in place (albeit of varying levels of maturity) and these accountability systems often had much more of an impact on teacher practice than the CSR models themselves. In some cases, there was synergy between the models and the states' own reform agendas, but in other cases, teachers felt as if they were being asked to achieve 2 independent goals. The states varied in their levels of support of schools' CSR efforts, depending on the primacy of CSR in the state reform picture and the political will and experience of the individuals in charge of CSR at the state level. Implications for the policy and practice of states, reform design teams, and district and school educators are discussed.