The purpose of this qualitative case study was to examine what influenced the decision making of middle grades preservice teachers and how middle grades preservice teachers used cases as a strategy to foster decision making. Participants were seven middle grades preservice teachers from a small, private, Christian college in the southeast. Each participant was a case study. Data sources included interviews, class discussions, and artifacts. Within-case analysis and cross case analysis were used in the study. Findings indicate that participants had common and differing themes for what influenced their decision making and for how they used cases as a strategy to foster decision making. All participants were influenced in their decision making by their field experiences, personal experiences, and other people. Some participants were also influenced by other sources, needs and characteristics of students, and examining possible outcomes of decisions. Using cases as a strategy to foster decision making gave all participants the opportunity to reflect, helped them identify solutions to the dilemmas presented in the cases, and helped them examine consequences of the decisions they might make. Some participants used cases as a strategy to put them in the role of the teacher and to help them think about multiple perspectives.