These proceedings are a written record of the research presented at the 43rd annual meeting of the North American Chapter of the International Group for the Psychology of Mathematics Education (PME-NA) held in Philadelphia, Pennsylvania, and virtually. This year's conference theme is "Productive Struggle: Persevering through Challenges." The aim of using this theme is to encapsulate an idea of hope towards the future: that through struggle, and through scholarly work, engagement in community, and sustained effort towards improvement, PME-NA can truly make a difference in the lives of teachers and students, and in mathematics education broadly in the continent of North America. The papers accepted comprised 81 research reports, 158 brief research reports, 121 Posters, and 15 Working Groups or Research Colloquia. [Individual papers are indexed in ERIC.]