Context: Limited literature explores professional preparation of program directors (PD) to lead an athletic training education program (ATEP). Objective: To explore challenges, effectiveness, leadership, and PD role selection. Design: Descriptive and qualitative exploratory email survey. Setting: Educational. Participants: Emails were sent to 345 PDs from a Commission on Accreditation of Athletic Training Education (CAATE) listing. Main Outcome Measure(s): Measures of central tendency were used to observe years of experience, role selection (applied versus appointed), education level, and gender. Program Director effectiveness, leadership, and challenges were grouped according to common themes. Results: Most PDs (82.5%; n = 99) reported having one to ten years of experience. Mean years of experience was 7.46 (±6.36) years. A majority, 61.7% (n = 74), reported having applied for their position. Educationally, 54.2% (n = 65) held doctoral degrees compared to 45.8% (n = 55) whose highest degree was a masters degree. Six themes emerged for PD effectiveness and challenges. Lastly, seven themes regarding leadership were described. Conclusions: Program Directors should approach their role with savvy, caring, and humanistic attitudes, developed by professional preparation. Firm in their convictions and vision, PDs also are viewed as empathetic advocates for students. Program Directors play a critical role in the advocacy of the profession within institutions of higher education through professional preparation of students. Several themes pertaining to professional preparation of PDs may positively impact the profession. Future PD's should seek educational programs that prepare them for these challenges of the position, such as professional preparation in education and higher administration or curriculum and instruction.