Standardized patients (SPs) are a very important aspect of healthcare simulation education. To have a successful SP simulation experience, the case development must be accurate and comprehensive. In addition to the carefully developed case scenario, SP training is equally important. The SP’s completion of the checklist must be accurate and consistent. The SP feedback has to be carefully structured because it can have a lasting impression on the learner. SP simulation provides the opportunity for the most realistic simulations in a safe environment. Initial objections toward using SPs include the high cost of implementation; the so-called “Hollywoodization” of the hard sciences; and a skepticism that an actor, not a trained healthcare professional, could correctly help assess a learner’s skills. This chapter discusses the history of SP simulation and describes the process for SP simulation case development, SP training, implementation, and evaluation.