While many education policies target test scores as a contemporaneous measure of student learning, a common concern is that these policies may generate higher test scores in a way that fails to translate to more important student outcomes in the long run. I use administrative data from North Carolina and two regression discontinuity designs to estimate the impact of school accountability pressure under No Child Left Behind on elementary students' test scores and their long-run outcomes at the end of high school. I find modest positive effects on elementary test scores and a significant increase in SAT scores years later. There is some evidence for a small increase in high school GPA, mixed evidence for an increase in students intending to attend a 4-year instead of a 2-year college, and no effect on high school graduation or intention to attend any college. Further evidence suggests the effect on SAT scores may be explained by persistent test-score effects in years after accountability exposure. Altogether, these results lend support to a mixed story for No Child Left Behind: while accountability pressure led to a long-run increase in skills captured by tests, these learning gains were not strong or broad enough to yield meaningful improvements in other long-run outcomes like educational attainment.