It's the biggest risk many student athletes face when they step in between the lines; playing.
No matter the sport, getting hurt is a part of the game.
It's rare, but some injuries are so severe, they leave athletes unable to ever walk again.
When this happens, who pays for the extensive medical bills?
In Roanoke City, the school system helps; it paid over $55,000 for its insurance policy last year.
But not every school system does this; most families have to take out their own policy; a dangerous game if a family is uninsured.
"We've never had to deal with one but you never know," said Butch Tyree, Athletic Director at Northside High School in Roanoke County.
The field is safest when it's empty. That's not what fields are made for.
Student-athletes know what they're signing up for when they play a Virginia High School League Sport.
Sometime's its the parents that don't.
"I can't recollect ever having a question about the catastrophic insurance through the Virginia High School League," said Tracy Poff, Athletic Director at Eastern Montgomery High School in Montgomery County.
If your child is VHSL eligible, he or she automatically qualifies for the state's catastrophic insurance policy.
Every VHSL school pays a $5.75 cent premium per student athlete to be insured under the catastrophic policy.
That policy kicks in when the medical bills total a minimum of $25,000 and is capped at a lifetime $3 million.
"It's a catastrophic insurance that helps kids who the insurance above and beyond what they already have for severe accidents," Poff said.
But what happens to families when the injury deductible doesn't cross $25,000? It depends.
"To be honest with you, I never wanted either of my kids to play football," said Tina Moran, who echoes the way many parents feel when their children are on the field.
Her son Dylan plays offensive and defensive line for Northside High School in Roanoke County.
Allowing Dylan to play football wasn't easy, but having insurance made her decision easier.
"I've been lucky that I have a federal job and good insurance, and only had to use it for sports-related injuries. Maybe about six times in the past ten years and I've been lucky that it's paid for that," Moran said.
Some families aren't so lucky, plenty don't have insurance, but still the kids want to play.
In the VHSL handbook, the language doesn't require student-athletes to have insurance.
Instead it encourages schools to make sure kids are covered, an encouragement many schools take very seriously.
"The first thing we check for is the physical form that's provided by the Virginia High School League and first thing for is 'do they have a policy'?" said Tyree, "If they don't, then we do not allow an athlete to participate without insurance."
Most school systems offer various "school day insurance" policies families can buy.
Depending on the school system and the policy, on average, a family can pay between 35 and 225 dollars to insure a child to play football or be covered if an accident happens at school.
"We've had three athletes purchase the plans. It's 35 dollars for a football coverage plan," said Tyree.
The good thing about a plan like this, it's something.
The bad thing; these school day plans are meant to be supplemental, but uninsured families still rely on them as the primary insurance.
"If they play football, they have to have a football coverage also because there are more emergency room, things happen," Tyree said.