The No Child Left Behind Act (NCLB) has emphasized the role of high-stakes tests (HSTs) designed to increase accountability for schools and improve student achievement. Under NCLB, English language learners (ELLs) must be included in such tests. Educators must then make critical decisions concerning how to include ELLs in such HSTs in ways that the tests are fair and also address their learning needs. Factors to consider include the selection of appropriate testing accommodations and the accurate interpretation of test results. This paper discusses key issues and major concerns about ELLs and HSTs. It also proposes solutions to both expected and unexpected problems.