INTRODUCTION: Moral distress occurs when providers feel powerless to provide ethical health care. We analyzed how abortion providers discuss moral distress since the Dobbs decision. METHODS: In 2023, we distributed an IRB exempt survey measuring moral distress to U.S. abortion providers through professional listservs. Surveys included an optional open-ended section where participants reflected on their experience of moral distress. Using thematic analysis, we compared open-ended responses between providers practicing in states protective and restrictive to abortion. Open-ended responses were deidentified, so we categorized “protective” and “restrictive” based on the written description of practice environment. RESULTS: Of 253 practitioners who completed the survey, 57% practiced in “protective” states and 43% practiced in “restrictive” states (using Guttmacher's classifications). Of these, 164 (64%) completed the optional, deidentified, open-ended section. Providers who indicated practicing in restrictive environments experienced moral distress arising from being forced to turn patients away or provide substandard care, the instability and ambiguity of abortion laws, and feeling powerless to use the specialized skills central to their identities as providers. Providers who indicated practicing in protective environments experienced moral distress arising from witnessing burdens placed on patients seeking care and the substandard care out-of-state patients received, a lack of resources to accommodate increased clinical volume, and encountering restrictive institutional policies despite the protections afforded by permissive state policy. CONCLUSION: Restrictions on abortion care can harm providers through their experiences of moral distress. Moral distress can lead to provider burnout and attrition, which exponentiates provider shortages and can ultimately lead to poor patient outcomes.