In today's era of high stakes testing and accountability, school principals are confronted with many difficult challenges in addition to those traditionally experienced by principals given the advent of No Child Left Behind (NCLB) and the many mandates each school principal must report on annually. With mandated curriculum standards and widespread demand to improve student achievement, principals face a multitude of administrative tasks. As the school accountability deadline to meet the 2014 federal objective of the No Child Left Behind Act of 2002 rapidly draws closer for the majority of states, this federal legislation has created increasingly high stress levels, potentially the highest ever, for principals across the country. However, elementary school principals are responding to these extreme demands and challenges in a multitude of ways. Both mental and physical strategies used as coping mechanisms are being employed effectively to combat the negative effects of work-related stress. The purpose of this qualitative study was to examine the self-perceived physical and mental impact of work-related stress on school principals and the impact the stress had, if any, on school climate. Further, the study explored the coping mechanisms principals reported using to manage stress. Analysis was completed on data obtained from semi-structured interviews of 10 elementary school principals, site observations at the school locations of the participating elementary principals, and Annual Customer Surveys (ACS) from each participant's school. The proposed study is significant to the field of education because this study provides the most current research regarding the mental and physical effects of work-related stress on elementary school principals in an era of increased accountability and the impact stress has on the school climate. Further, this study offers school principals a repertoire of effective coping mechanisms that can be utilized to help reduce their perceived stress levels. Over the time of the study, it was repeatedly reported by the principal participants that their work stress had increased, which was found to have impacted their health as well as the school climate. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]