As a result of the pressures of educational reform and high-stakes assessment, some schools run the risk of foregoing active, student-centered learning activities for building test-taking skills and the memorization of discrete facts (Gredler, 1999; Jackson & Davis, 2000). Coupled with the additional pressure to fulfill the expectations of "No Child Left Behind" (NCLB), educators may feel the need to abandon the tenets of the middle school philosophy for more teacher-centered instructional approaches. Since the enactment of the Kentucky Education Reform Act (KERA) in 1990, schools and teachers have been accountable for the achievement of students and implementation of the state's assessment standards. Using the responses of 216 educators from 17 middle schools in Northern Kentucky, this descriptive study explores middle grade teachers' perceptions of how high-stakes testing and state accountability standards influence instructional strategies utilized in the classroom. Results indicate that though teachers acknowledge the importance of including active and student-centered strategies on a consistent basis, the state tests seem to drive the curriculum and warrant more teacher-focused instructional methods--lecture, worksheets, and whole-class discussion. In addition, recommendations are offered to improve instructional practice, enhance middle grades teacher preparation programs, and guide future research. (Contains 3 tables.)