While the international agenda has promoted the need to diversify the teacher workforce, research on student teachers with disabilities is rare. However, initial teacher training (ITT) faces a meaningful dilemma, that calls for a critical examination: it has the duty to provide reasonable accommodations and, at the same time, it is accountable for training teachers through professional standards (“dilemma of professional competence”). This article provides a systematic review pertaining (1) the main issues related to students with disabilities in ITT and (2) the different forms assumed by the “dilemma of professional competence” within the programme. Twenty empirical studies, published between 1990 and 2018, were included. Seven thematic areas and three forms of the dilemma (institutional, personal and cultural) emerged from the analyses. Key findings confirm that students with disabilities’ personal journey is fraught and highly complex in ITT. While they also reveal the crucial role of the “dilemma of professional competence,” they show the need to reframe it considering the active role played by students with disabilities in adopting coping strategies, beyond the reasonable accommodations received, and the potential of a pluralization of the teacher competence profile, beyond the rigid idea of a standard one.