U.S. academic libraries exist in an unusual space, as they are both providers of access to computers, the Internet, and databases and electronic products, and producers of electronic content through digital repositories and electronic journals. They are part of larger organizations, yet the other parts of these larger organizations are not libraries or even library-related. In addition, there are factors — beyond merely decision-making processes — that make accessibility a far more fraught concern for academic libraries. U.S. academic libraries are also influenced by the policies of new media content creators that maximize their profits through streaming on their own platforms. Further, academic libraries have taken on new roles related to information access, including the collation and distribution of electronic materials through campus digital repositories of preprints, theses, and other works created by faculty, staff, and students. Moreover, in some cases, libraries have stepped into the role of publisher, particularly with respect to open-access electronic journals. For people with disabilities, accessibility in all of these facets is essential for their ability to be equal users of the library. These various roles of academic libraries create a distinct set of legal, technological, and ethical pressures related to ensuring accessibility for individuals with disabilities, which will be explored in this article, along with the potential for academic libraries to become leaders in accessibility in libraries and in broader society.