The term "assistive technology" (AT) elicits widely varying responses from educators, service providers, and consumers of AT even within the relatively small disability, special education, and related services community. For the most part, AT advocates for the low-incidence disability populations (i.e., blind or low vision, deaf or hard hearing) mostly focusing on providing an alternate format or alternate medium of the original material, in which, the format is in a form that is as nearly identical to the original material as possible. This view is typified in the final report on the National Instructional Materials Accessibility Standard (NIMAS, 2003), which focused almost completely on developing an alternate-medium solution for disability access to content in a digital format. This article forwards the idea of instructional design as a key element of AT, providing a focus on the access-to-learning side of AT, and on the group of individuals with high-incidence disabilities referred to in the NIMAS document as the "more comprehensive group." This is the group for whom "access to the medium of print" does not necessarily translate into "access to comprehending print." The authors focus on the need to incorporate effective instructional design in creating useful and effective ATs and describe criticisms of the instructional design of conventional textbooks and educational software. Arguments are detailed within three areas: (a) difficulties inherent in traditional print materials; (b) adapting digital content for persons with disabilities; and (c) design for current computer-based commercial educational products.