Preschool children are being expelled from child care programs at an astonishing rate, often because of challenging behaviors such as aggression, tantrums, and noncompliance. Teachers say they need more training in how to manage these behaviors in child care settings. Early childhood mental health consultation (ECMHC) has been shown to build provider's capacity to better cope with challenging behavior. This article describes the lessons learned from interviews about 20 children receiving ECMHC who nonetheless exited their child care settings because of behavioral concerns. The authors outline the common characteristics of children at risk for expulsion, as well as the common characteristics of programs that may exacerbate challenging behaviors. A discussion of how ECMHC can help reduce the risk for expulsion is included along with a detailed list of specific strategies consultants recommended for use with teachers.