The aim of this study was to explore teachers' perceptions and experiences of supports and obstacles to engaging students with multiple and severe disabilities (MSD) in communicative interactions at school. Eleven teachers of students with MSD participated in two in-depth interviews. Interview transcripts were analysed for narrative structure and content themes. Inter-coder reliability for coding of content themes was 87.5%. Participants identified a broad range of factors, including: characteristics of individual students, attitudes, perceptions and beliefs of teachers and other staff, class structure, staffing, opportunities for collegiality, resources, funding, infrastructure, collaboration with speech-language pathologists, appropriate communication education for teachers, the role of government departments, and broader societal factors. The findings suggest that there are complex contextual influences on the communicative interactions of students with MSD. While inadequate systemic supports appear to contribute to low frequencies of communication, systemic factors can be structured so that students participate in activities and have opportunities for communication. Further research is required with teachers of students with MSD to substantiate these findings.