This chapter focuses on the participation and social interaction of pupils with low-incidence disabilities in the Swedish educational system with the goal of relating policies and practices in education for learners with low-incidence disabilities. Sweden has a welfare system that ensures that all low-incidence learners and their families receive support in education and in their everyday life. The research section concentrates on studies that focus on participation and social interaction in an educational context (training school), which is an adapted education program for low-incidence learners characterized by its high staff ratio and individualized forms of teaching. Despite legislation, policies, and intentions that Swedish schools shall include all pupils, it is still a challenge for the Swedish school system to provide education for low-incidence learners in inclusive environments. Research shows that low-incidence learners primarily have vertical relations with teachers and assistants in school, and that there is a lack of horizontal relationships with peers. The greatest challenge is to create learning environments that contribute to building relationships between low-incidence learners and learners without disabilities.