This study compared an integrated pest management (IPM) program with conventional, calendar-based pest control in nine North Carolina elementary schools. Both programs primarily targeted the German cockroach, Blattella germanica (L.). The IPM program relied heavily on monitoring and baiting, whereas the conventional approach used baseboard and crack-and-crevice sprays of insecticides. Within the constraints of an existing pest management contract, we quantified service duration, materials used, cost, levels of cockroach infestation, and the pesticide residues generated by the two service types. IPM services were significantly more time-consuming than conventional services, resulting in a significantly higher cost associated with labor. Nevertheless, the two types of treatments incurred similar total costs, and the efficacy of both treatments was also similar. Most importantly, pest monitoring, a central element of the IPM program, revealed few cockroaches and indicated that most of the conventional treatments were unnecessary. Environmental residues of the organophosphate pesticides acephate, chlorpyrifos, and propetamphos were significantly higher in swab samples taken in the conventionally treated schools. This study demonstrates that an IPM program is an appropriate and preferable alternative to conventional methods of pest control in the school environment.