The incidence of Certified Athletic Trainer (ATC) coverage in Idaho secondary schools is below the national level of 35% (Lyznicki, Riggs, and Champion, 1999). The greatest concentration of ATCs employed in Idaho secondary schools is in higher populated schools, although 75% of schools in the state of Idaho at the time of this study had student populations of less than 750. This notable lack of coverage in smaller schools is a distinct disadvantage for student-athletes. Overall, secondary school sports health care must increase for smaller populated schools. Regarding ATCs who are currently employed, the athletics/activities directors' perceptions of ATCs' roles and responsibilities revealed they expect ATCs to spend more time completing activities outside the Role Delineation Study domains, and these duties were perceived as important by athletics/activities directors. Athletic directors must be cognizant of the roles and responsibilities of ATCs in the secondary school setting as outlined by the NATABOC. Furthermore, this study suggests way to increase ATC incidence and optimize sports health care coverage in the secondary school setting.