The evolution of simulation use in nursing and health care education is a relatively short but a deeply rich one. Simulation use involves several areas and extends beyond the technology of simulators. Evolution of simulation includes technological advances, but it also includes advances in accessibility. Teaching and pedagogical advances, combined with advances in research, are all part of the evolution. As nursing curricula begin to use this tool to greater extents, the evolution and role of simulators are better understood. This article explores the evolution of simulation use in nursing education in the context of technology, accessibility, and teaching pedagogy.