Driven in part by federal law, accessibility (a11y) support for disabled users is becoming ubiquitous in commodity OSs. Some assistive technologies such as natural language user interfaces in mobile devices are welcomed by the general user population. Unfortunately, adding new features in modern, complex OSs usually introduces new security vulnerabilities. Accessibility support is no exception. Assistive technologies can be defined as computing subsystems that either transform user input into interaction requests for other applications and the underlying OS, or transform application and OS output for display on alternative devices. Inadequate security checks on these new I/O paths make it possible to launch attacks from accessibility interfaces. In this paper, we present the first security evaluation of accessibility support for four of the most popular computing platforms: Microsoft Windows, Ubuntu Linux, iOS, and Android. We identify twelve attacks that can bypass state-of-the-art defense mechanisms deployed on these OSs, including UAC, the Yama security module, the iOS sandbox, and the Android sandbox. Further analysis of the identified vulnerabilities shows that their root cause is that the design and implementation of accessibility support involves inevitable trade-offs among compatibility, usability, security, and (economic) cost. These trade-offs make it difficult to secure a system against misuse of accessibility support. Based on our findings, we propose a number of recommendations to either make the implementation of all necessary security checks easier and more intuitive, or to alleviate the impact of missing/incorrect checks. We also point out open problems and challenges in automatically analyzing accessibility support and identifying security vulnerabilities.