English as a medium of instruction (EMI) has gained wide popularity over the last decade in India. The number of children studying in English-medium schools has increased by 274% between 2003 and 2011 to more than 20 million students (National University of Education, Planning and Administration, 2012). With the increase in demand for English-medium education, there has been a surge in low-cost private English medium schools across India including Bihar. However, there is a noticeable paucity of research investigating the micro-level aspect of using EMI in such schools in Bihar. This is a micro-level study focusing on the challenges faced by the teachers in the implementation of EMI in actual classroom situations. It aims to give voice to their concerns and requirements. The study covers three low-cost private English medium schools in Patna, Bihar. The data was collected using semi-structured interview. Findings reveal that teachers are challenged by students’ language limitations, their own limited language abilities and lack of awareness of teaching methods, pedagogical issues, and lack of professional development for in-service teachers. Based on these findings, practical and contextually relevant suggestions are made to ameliorate the situation for both the teachers and the students.