For decades, teacher educators and others have looked critically at the way teachers are initially prepared and during the last ten years the calls for reform in teacher education have become even more frequent. Some programs have responded to those demands and made substantial and long lasting changes. This qualitative study reports on data gathered during interviews with deans and other senior teacher education program heads who have been leaders of major long term programmatic changes in their institutions. Interviewees described the major reforms that occurred under their leadership and described the origins of each initiative and the positive and negative influences on these reform efforts. Conclusions focus on the importance of faculty development and a coherent program foundation, the centrality of context, and the re-visioning of relationships between states and teacher education programs.