Objectives: Describe the experiences of leaders of abortion services. Define the leadership role and explore leaders’ motivations, challenges, sources of resilience, impact of stigma on their lives and work, and impressions of the future of abortion care leadership. Methods: In-depth interviews with 29 US abortion-care leaders in diverse practice settings. Interviews were audio-recorded, transcribed, and analyzed using a grounded theory approach. We also used self-administered surveys using validated scales to assess their experiences. Multivariate regression performed using STATA14. Results: Leaders’ roles included a wide range of activities with no “typical day.” All participants expressed passion for their work, but described intense challenges, including: personal costs, harassment/violence, stigma, isolation, burnout, legislative burdens, and constant scrutiny. Participants in politically hostile states described adapting to the chronic stress of such environments and had lower internalized stigma (P=-3.45; p<0.05) and burnout (P=-0.53; p<0.05) than participants in less restrictive states. However, the July 2015 video campaign brought acute stress and fatigue. Participants interviewed after the videos reported greater judgment by others (P=-4.50; p<0.05) and higher burnout (P=4.26, p<0.05) regardless of location. Despite this, participants demonstrated humor and resilience. Regarding the future, most had no succession plan and believed it would be hard to find their replacement. Participants identified the lack of a "leadership pipeline" as a key challenge. Conclusions: Abortion care leadership is uniquely challenging, and training and preparation are needed. Movement-wide priorities need to expand beyond physician training to include the development and mentorship of new leaders in abortion care.