Working with students with moderate to severe disabilities (MSD) requires a broad set of competencies that, at minimum, include the ability to provide individualized adaptations to the general education curriculum, collaborate with general educators, implement systematic instructional strategies, provide assistive technology supports, address behavioral issues, oversee paraprofessional and peer support, meet healthcare demands, provide functional skill instruction, and use physical management techniques (Browder & Spooner, 2011; Collins, 2007a; Snell & Brown, 2011; Westling & Fox, 2009). A special education teacher who works with students with MSD may experience a sense of isolation within his or her school as the only teacher with expertise in these areas to meet the needs of these students. This is exacerbated when a teacher of students with MSD works in rural geographic areas where he or she may be the only teacher skilled in specialized techniques within the entire district (Collins, 2007b).The Commonwealth of Kentucky has a large rural population. According to statistics from 2011 cited by the Rural Assistance Center (RAC; http://www.raconline.org/states/ kentucky/), 41.4% of Kentuckians live in rural regions of the state; in particular, the rural eastern region of the state lies in the Appalachian Mountains, an area noted for its high rate of poverty. In a 2013-14 report (Appalachian Regional Commission; http://www.arc.gov/ research/MapsofAppalachia. asp?MAP_ID71), the majority of the most distressed Appalachian counties fall with the borders of Kentucky. The RAC (2011) reported that the rural per capita income in Kentucky was $28,767, lagging behind the average per state capita income of $33,988. Specifically, 23.4% of rural Kentuckians were living in poverty as compared to 16% of urban Kentuckians, while 24.7% of rural students completed high school as compared to 13.6% of urban students. These figures can be compared to an average national rural salary figure of $33,247, a national rate of rural poverty of 18.3 %, and a national rural high school completion figure of 16.9%.The effect of low high school graduation rates, unemployment, and poverty on education in rural Kentucky, and especially the Appalachian region, is clear (Collins, 2008), making it difficult to recruit or retain teachers to rural Kentucky, especially those with expertise in MSD (Collins, 2007b). As in other states (e.g., Robertson &. Singleton, 2010), those who accept jobs in the field of special education are often hired under an alternate route to certification (Option 6) in order to meet the demand for personnel, creating a situation where teachers enter the field without the expertise to work with students with low incidence disabilities (Collins, 2007b; Hager, 2011). The Education and Professional Standards Board (EPSB) is the governing organization for teacher certification in Kentucky. According to the EPSB (2013a), only three institutions of higher education in the state (i.e., Morehead State University, University of Kentucky, University of Louisville) offer an approved alternate certificate program in MSD. This creates an additional challenge of providing coursework and clinical supervision to students in alternate certificate programs who may be located at a great distance from these IHEs. Thus, coursework is often offered through distance education technology (Collins, Baird, & Hager, 2009; Collins, Schuster, Ludlow, &. Duff, 2002; Glomb, Lignuagaris/ Kraft, & Menlove, 2009; Hudson, Knight, &. Collins, 2012; Ludlow &. Duff, 2009; McDonnell et al., 2011; Sebastian, Egan, &. Mayhew, 2009; Spooner & Lo, 2009; Thompson, Klass, & Fulk, 2012; Vasquez & Serianni, 2012) with clinical supervision through both face to face visits and remote technology (Hager, Baird, Keramidas, &. Spriggs, 2012; Jung, Galyon-Keramidas, Collins, &. Ludow, 2006; Scheeler, McKinnon, &. Stout, 2012). …