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Context: Access to athletic trainers (ATs) in high schools is crucial for student-athlete (SA) safety. Although most high schools in the United States have access to athletic training services (ATS), no authors have longitudinally compared ATS trends between public (PUB) and private (PVT) school sectors. Objective: To compare ATS trends between PUB and PVT schools from the 2018-2019 through 2022-2023 academic years. Design: Longitudinal cross-sectional study. Setting: Online survey. Main Outcome Measures: High school responses to the Athletic Training Locations and Services survey from all 50 US states and the District of Columbia were queried from the 2018-2019 to 2022-2023 academic years. Average numbers of SAs (SAs), sports (Sports), full-time ATs (FtATs), part-time ATs (PtATs), and the sum of full-time and part-time ATs (ATs), along with the average weekly contracted hours (CHrs) and actual hours (AHrs) per school, and ratios of SAs : ATs, Sports : ATs, CHrs : SAs, CHrs : Sports, AHrs : SAs, and AHrs : Sports were examined to track ATS trends over 5 years and compare PUB vs PVT schools. Results: Public schools had higher SAs and Sports vs PVT schools (both P < .001). Private schools had higher ATs, CHrs, and AHrs than PUB schools (all P < .050). Ratios of SAs : ATs and Sports : ATs were higher in PUB schools, whereas CHrs : SAs, AHrs : SAs, CHrs : Sports, and AHrs : Sports were higher in PVT schools (all P < .050). From 2018-2019 to 2022-2023, PUB schools increased Sports and Sports : ATs; PVT schools increased SAs, Sports, ATs, and SAs : ATs (all P < .050). Over the years, PUB schools decreased CHrs : Sports and AHrs : Sports; PVT decreased CHrs : SAs, AHrs : SAs, CHrs : Sports, and AHrs : Sports. FtATs increased in both sectors, whereas PtATs decreased in only PVT schools. Conclusions: Overall, ATS were more extensively provided in PVT schools, based on ATs and ATS hours. Both sectors increased FtATs, which is encouraging. However, as SAs and Sports increased, ATS provided per SA and sport declined. © by the National Athletic Trainers’ Association, Inc.