Few researchers have examined sex trafficking of girls with intellectual disabilities (IDs). Drawing from 54 juvenile sex trafficking (JST) cases, this exploratory, mixed methods study compared 15 JST cases involving girls with ID with 39 JST cases involving girls without ID. Findings revealed a disproportionate risk for exploitation in JST for girls with ID, endangering circumstances creating vulnerability among this population, as well as the perpetrator–victim dynamics that complicate prevention and intervention. Complicating dynamics included victim lack of awareness of exploitation and its endangerments, inability of victims to self-identify, and the relative ease with which traffickers manipulated these girls. The disproportionate risk faced by girls with ID substantiates the need for enhanced safeguards to prevent sexual exploitation of girls with ID including stiffer penalties for those who exploit and buy sex with youth with disabilities.