Collectively, different sets of research lead to one conclusion--that most students with extensive support needs (ESN) are not being given appropriate, accessible, and meaningful opportunities to learn (OTL); when they are provided such OTL, however, students with ESN are learning. The purpose of this article is to (a) provide a general foundation for what constitutes OTL in general education literature, (b) define OTL in a way that is more complete when considering educational opportunities for students with ESN, (c) provide an overview of the current state of OTL for students with ESN, and (d) discuss additional elements that improve OTL for students with ESN. Given the proposed construct of OTL, we argue that students with ESN are not consistently or regularly provided appropriate and accessible OTL standards-aligned content. This article identifies elements that are necessary for providing consistent and effective OTL for students with ESN, facilitating their progress toward grade-level standards-aligned content, and outlines implications for future research.