School choice policies are expanding rapidly across America, but new reporting from Cedar Rapids, Iowa reveals a complex reality: while some families benefit from alternatives to traditional public schools, the poorest and most vulnerable students—including those with disabilities—are increasingly left behind in under-resourced neighborhood schools. Cedar Rapids lost about 230 students and over $1.8 million in funding to a new charter school in just one year, forcing the district to consider closing up to six elementary schools. Private schools receiving public ESA funds ($8,000 per student annually) can legally reject students with disabilities or behavioral challenges, while public schools must serve all children regardless of need.