Response to intervention (RTI) is advocated in elementary school as a system-wide, multitiered model of academic and behavioral interventions. Middle schools have begun adopting RTI models based on these existing elementary models. This investigation into current middle school RTI practices describes technical aspects as well as some of cultural and contextual issues surrounding implementation. The study included multiple data collection procedures including surveys, discussion groups, phone interviews, and site visits. Although many schools reported substantial progress with implementation, they recognized rigorous implementation of RTI posed such on-going challenges as changes in staffing, curricular realignments, very limited selections of screening and progress monitoring tools aligned with their curriculum, and scheduling of secondary and tertiary level interventions. (Contains 5 tables and 2 footnotes.)