Fractions are an essential foundational skill for future mathematics success (NMAP, 2008). The purpose of this article was to review current instructional practices for teaching fractions to struggling learners and to examine the quality and effectiveness of contemporary research with a view to indicating directions for future research. A comprehensive search of literature published between 1990 and 2008 resulted in the identification of 10 empirical studies that targeted fraction skills for struggling learners. Results indicated that three interventions, found to be effective for improving outcomes in mathematics for struggling learners, were also effective for teaching fractions: graduated sequence, strategy instruction, and direct instruction. In addition, explicit instruction was identified as necessary for improving students’ performance in fractions. Overall, this review highlighted the paucity of research in this critical mathematical content area.