In this article, Phyllis Jones of the Department of Special Education at the University of South Florida and Elizabeth West from the University of Washington explore key issues in respect to teacher education for teachers who teach pupils with severe and profound learning difficulties in the USA. Issues relating to quantity and quality of teachers are discussed in the context of policy and practice in the USA. Reflections related to teacher education delivery in the USA, in terms of case-based learning and distance education, for example, and the content of teacher education courses, for example, in terms of helping teachers to understand the needs of pupils with learning difficulties and the promotion of evidence-based practices, are discussed. Phyllis Jones and Elizabeth West suggest that their reflections can contribute to continuing discussions about teacher education in the UK for teachers who work with pupils with severe and profound learning difficulties.