The Third International Mathematics and Science Study (TIMSS) 1999 Video Study examined eighth-grade mathematics teaching in the United States and six higher-achieving countries. A range of teaching systems were found across higher-achieving countries that balanced attention to challenging content, procedural skill, and conceptual understanding in different ways. The United States displayed a unique system of teaching, not because of any particular feature but because of a constellation of features that reinforced attention to lower-level mathematics skills. The authors argue that these results are relevant for policy (mathematics) debates in the United States because they provide a current account of what actually is happening inside U.S. classrooms and because they demonstrate that current debates often pose overly simple choices. The authors suggest ways to learn from examining teaching systems that are not alien to U.S. teachers but that balance a skill emphasis with attention to challenging mathematics and conceptual development.