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Educational assessment is a part of accountability in K-12 education, and teachers often face ethical dilemmas in assessment practices. We conducted a comparative qualitative study of the decision rationales regarding assessment practices of teachers in the United States and China. Coding based on the responses of 255 teachers (102 American teachers and 153 Chinese teachers) on 14 assessment scenarios aligned with seven categories revealed informative findings. American teachers and Chinese teachers demonstrated very different views on eight out of the 14 scenarios. Educational assessment was a complex and contextual practice, and teachers’ decision-making was guided by various aspects including culture, purposes of assessment, types of assessment, students, policy and rules, and support of learning.