During the past 15 years there has been widespread adoption of simulation in health care education as a method to train and assess learners. Multiple factors have contributed to this movement, including reduced patient availability, limited faculty teaching time, technological advances in diagnosis and treatment that require a new skills set, greater attention to patient safety with the need to reduce medical errors, and a focus on outcomes-based education. In this discussion, simulation refers broadly to any device or set of conditions that attempts to present the patient authentically. While simulation offers many advantages over traditional methods of teaching, there are several challenges that must be addressed to ensure its effective use. This article presents the range of available simulation technologies, explores the challenges that health care educators face when using this method, provides an example of a successful program that has integrated simulation into the culture of learning at its institution, and discusses an approach to maximizing the effectiveness of simulation as a means to learning and practicing skills in a safe, interactive environment.