The purpose of this descriptive study was to explore utilization of nurse substitutes in the school setting in Illinois. The literature described personnel who staff the school health office in the absence of the school nurse and the barriers to obtaining nurse substitutes. There were no empirical studies conducted on school nurse substitutes in the literature. Thus, a sample of 148 Illinois school nurses was recruited to complete a 20-item online survey. In the absence of a school nurse, 10.1% of health offices were not staffed, 37.8% were covered by a nurse who was simultaneously responsible for their usual assignment, and 25.7% were staffed by nonlicensed personnel. Therefore, 73.6% of the respondents' assignments had no registered nurse immediately available the most recent day the nurse was absent. (Contains 1 table.)