This descriptive case study examines six mathematics teacher educators' (MTEs) perspectives on their design of content courses for elementary preservice teachers. By focusing on MTE's design goals and considerations for their mathematics content courses, the means by which they achieved these course design goals, and the challenges they encountered as they carried out their design goals, this study adds to the image of mathematics content courses, and sheds light on the work of MTEs. Our findings indicate that MTEs design content courses that take a learner-centered approach to instruction and that in designing learner-centered content courses, MTEs face a variety of challenges. Implications for the professional development of MTEs are discussed.