Test-based accountability systems aim to direct the behavior of educators toward the improvement of student achievement. The No Child Left Behind (NCLB) Act codified accountability as the national educational blueprint, requiring schools to increase test scores incrementally so that all students are proficient in reading and math by 2014. Yet, despite the stated intent of NCLB to improve outcomes for all students, particularly those who have been historically neglected, educators and others may adopt a series of "gaming" practices in order to artificially inflate schools' passing rates. Such practices include giving students a special education classification to exclude them from high-stakes tests, retaining students in grade to delay test-taking, diverting attention away from subjects not evaluated on high-stakes tests, teaching to the test, and cheating. In this article, the author discusses two of the dilemmas presented by a less-well-known gaming practice: educational triage. The insights offered here derive from an ethnographic study of an urban elementary school in Texas, to which she has assigned the pseudonym "Beck Elementary." By educational triage, she means the process through which teachers divide students into safe cases, cases suitable for treatment, and hopeless cases and ration resources to focus on those students most likely to improve a school's test scores. (Contains 10 endnotes.)