High quality teacher-student interactions are critical for the healthy social-emotional, behavioral, and academic development of middle school students. However, few studies have explored patterns of teacher-student interactions in middle school classrooms or the relation between teacher-, classroom-, and school-level factors and patterns of interaction. The current study employed latent profile analyses (LPA) to identify patterns of teacher-student interactional quality in a sample of 334 teachers from 41 schools serving middle school students within the Mid-Atlantic region of the U.S. Three distinct profiles of teacher-student interactional quality were identified, characteristic of higher, lower, and intermediate quality, and were differentially related to teacher, classroom, and school characteristics. Compared to classrooms with lower interactional quality, classrooms with "higher" or "intermediate" profiles were more likely to be taught by early career teachers, to have higher rates of observed student cooperation, and to be in schools in rural fringe areas. Classrooms with lower interactional quality were more likely to have larger student-to-teacher ratios and higher rates of student disruptive behaviors than classrooms with intermediate interactional quality and to be in schools with a higher percentage of out-of-school suspensions than classrooms with higher interactional quality. These findings suggest that interventions at the teacher, classroom, and school levels, such as consultation to support teachers' effective classroom management, alternatives to out-of-school suspensions, and smaller student-to-teacher ratios may promote positive teacher-student interactions. [This paper was published in "Journal of School Psychology" v93 p79-97 2022.]