The No Child Left Behind Act (NCLB) has mandated sweeping accountability in public education. Low-performing urban schools find themselves in the crossfire of political and educational divergence. Comprehensive school reform (CSR) models predate NCLB, but the impact of their implementation has been even more pronounced since the passage of NCLB. With adequate yearly progress as the national measure of school achievement, the lowest performing students in the lowest performing schools have turned out to be the most critical group to support. We compared the effects of two CSR models ("Success for All" and "Direct Instruction") in reading for urban middle school students with disabilities who were performing 2 or more years below grade level in reading. The results indicated that students with disabilities showed little or no reading skill gain from either comprehensive school reform model and remained markedly behind. Improving the skills of the lowest performing students in a timely manner appears to continue to be education's greatest challenge.