Although the Federal No Child Left Behind program judges the effectiveness of schools based on their students achievement status, many policy analysts argue that schools should be measured, instead, by their students achievement growth. Using a ten-year student-level panel data set from North Carolina, the authors examine how school-specific pressure associated with the two approaches to school accountability affects student achievement at different points in the prior-year achievement distribution. Achievement gains for students below the proficiency cut point emerge in response to both types of accountability systems, but more clearly in math than in reading. In contrast to prior research highlighting the possibility of educational triage, the authors find little or no evidence that schools in North Carolina ignore the students far below proficiency under either approach. They find that the status, but not the growth, approach reduces the reading achievement of higher performing students. Results suggest that the distributional effects of accountability pressure depend not only on the type of pressure for which schools are held accountable (status or growth), but also the tested subject.