Special education teachers for students with extensive support needs often and unwittingly make misinformed decisions. These decisions are situated within systems, which fail to support expertise development in teaching this population, resulting in decisions influenced by media, commercially available curricula, and outdated assumptions about possible student outcomes. We propose a framework for making and evaluating decisions about teaching students with extensive support needs to support teacher education in this area. Based on 45 years of research and theory, we propose that teacher educators should prepare teachers to (a) know what to teach; (b) know how to teach; and (c) identify who teaches students with extensive support needs. We further suggest that teacher education and teacher decision-making for students with extensive support needs should be evaluated based on the following basic questions: (a) Is it inclusive? (b) Is it dignifying? (c) Is it student centered? and (d) Is it evidence-based? A rationale and recommendations for practice are provided.