Despite a well-documented need for school health programs (SHPs) among schoolchildren, there is little school health funding in California and limited research on the role of those who manage SHPs. This qualitative study investigated the work of a selected group of school health administrators (SHAs) in California. Study aims were to explore SHA job pathways and responsibilities, the contextual factors influencing their work, and how they get their work done, given limited funding for SHPs. Thirty in-depth, semistructured interviews were conducted with SHAs and their staff, supervisors, and deputy SHAs. The main themes and subthemes are (1) district hierarchies marginalize SHAs and (2) in response to this marginalization, SHAs engage in brokering strategies to get their work done, including (a) raising awareness, (b) cultivating powerful allies, and (c) adjusting to working conditions. Despite structural disempowerment, SHAs have developed strategies to secure political support for SHPs and school nurses.