In this chapter, we start by defining what it means to be a counter and then explain what children need to be able to do to be successful at counting. Additionally, we define subitizing, explain its importance, and how it differs from counting. We complete the first section by discussing the importance of counting as a prerequisite to other aspects of arithmetic. In the following section, we discuss several challenges that counting poses for children experiencing mathematical difficulties, illustrated by examples from our research. One of these challenges includes the language of counting. In English, aspects of the language and sequencing of counting can be difficult for children, especially the teen number words, decade boundaries, counting above 100, and sequencing of numbers. Many of these characteristics are common to other languages too. Other aspects of counting that prove difficult for many children are maintaining one-to-one correspondence while counting unfamiliar sequences, understanding cardinality, finger gnosis, and using the formal symbolic notation for counting. In the final section of this chapter, we discuss and outline the activities that we have found to be useful to enhance the counting skills of children with mathematical difficulties.