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This study investigates how four instructors of elementary mathematics methods courses plan and implement teaching simulations designed for pre-service teachers (PTs) to practice instructional conversations. Instructor interviews were analyzed using a framework of persistent challenges. Results include ways that instructors approached planning (i.e., focusing on how to introduce simulations, sequence simulations, design simulations to meet PTs’ needs, or build PTs’ motivation) and highlight how instructors implementing teaching simulations may need additional support to anticipate ways to assess PT thinking and strategies for managing PT behavior. This work is important to support instructors in preparing PTs to engage in mathematical conversations in their elementary classrooms.