Early Intervention and Early Childhood Special Education (EI/ECSE) are critical services for children with disabilities and their families. Urban areas are charged with providing EI/ECSE services to a large number of children, who come from diverse racial, cultural, and linguistic backgrounds, and whose parents may or may not have economic resources. To better understand the nuances of EI/ECSE systems in urban contexts, we interviewed stakeholders in a large Mid-Atlantic U.S. city, examining the process of accessing EI/ECSE. We interviewed parents, medical professionals, early care providers, and special education personnel, and reviewed and analyzed artifacts using content analysis to inform the research questions and verify findings. Findings showed a strained system with both structural and situational challenges, specifically for families from diverse backgrounds.