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Teachers of the visually impaired (TVIs) regularly present tactile materials (tactile graphics, 3D models, and real objects) to students with vision impairments. Researchers have been increasingly interested in designing tools to support the use of tactile materials, but we still lack an in-depth understanding of how tactile materials are created and used in practice today. To address this gap, we conducted interviews with 21 TVIs and a 3-week diary study with eight of them. We found that tactile materials were regularly used for academic as well as non-academic concepts like tactile literacy, motor ability, and spatial awareness. Real objects and 3D models served as “stepping stones” to tactile graphics and our participants preferred to teach with 3D models, despite finding them difficult to create, obtain, and modify. Use of certain materials also carried social implications; participants selected materials that fostered student independence and allow classroom inclusion. We contribute design considerations, encouraging future work on tactile materials to enable student and TVI co-creation, facilitate rapid prototyping, and promote movement and spatial awareness. To support future research in this area, our paper provides a fundamental understanding of current practices. We bridge these practices to established pedagogical approaches and highlight opportunities for growth regarding this important genre of educational materials.