Students often misinterpret the equal sign (=) as operational instead of relational. Research indicates misinterpretation of the equal sign occurs because students receive relatively little exposure to equations that promote relational understanding of the equal sign. No study, however, has examined effects of nonstandard equations on the equation solving and equal-sign understanding of students with mathematics difficulty (MD). In the present study, second-grade students with MD (n = 51) were randomly assigned to standard equations tutoring, combined tutoring (standard and nonstandard equations), and no-tutoring control. Combined tutoring students demonstrated greater gains on equation-solving assessments and equal-sign tasks compared to the other two conditions. Standard tutoring students demonstrated improved skill on equation solving over control students, but combined tutoring students' performance gains were significantly larger. Results indicate that exposure to and practice with nonstandard equations positively influence student understanding of the equal sign.