Discrepancies between recommended and actual practices of school psychologists have plagued the field for decades. Previous studies have examined and identified differences in school psychology practices based upon geographical location within the United States as well as between community settings (e.g., rural, urban). The present study sought to fill a gap in the literature (Hosp & Reschly, 2002) by examining the actual and perceived needed practices of school psychologists in the East South Central (ESC) census division of the United States and compare those practices to the National Association of School Psychologists (NASP) Practice Model (NASP, 2020c). Sixty-five school psychologists from the ESC division completed an adapted and reproduced version of the NASP Membership Survey (Walcott & Hyson, 2018) measuring a number of demographic variables as well as their engagement in a variety of school psychologist activities and services using a 7-point Likert-scale. Participants rated their actual practice during the most recently completed school year and rated the level of engagement in those same practices they thought was needed to best serve students in their district during a typical school year. Results indicated that as a whole, school psychologists in the ESC division do not engage in a comprehensive service delivery model as recommended by NASP. Rather, their perceived need for services was more closely aligned to the NASP Practice Model (NASP, 2020c). State-level comparisons indicated that school psychologists in Alabama practice under a traditional gatekeeper of special education model (Merrell et al., 2006) compared to their counterparts in Kentucky and Tennessee. School psychologists in Kentucky reported more engagement in mental-health related services than participants from other states. Community-level comparisons indicated that school psychologists practicing in urban settings are more engaged in a comprehensive service delivery model than those practicing in rural or suburban areas. No specific practices were identified as more needed than others by school psychologists in rural settings. Implications for future research include analysis of organizational factors contributing to discrepancies with implications for practice related to advocacy efforts.