Purpose Simulation is increasingly becoming a valuable tool for training and educating students in communication sciences and disorders (CSD). The purpose of this study is to examine the impact of a mixed-reality simulation on CSD students' perceptions of their ability to apply clinical and counseling skills. Additionally, this study sought to investigate the overall efficacy and acceptance of this type of clinical simulation experience for undergraduate CSD students. Method A total of 29 undergraduate students participated in a clinical simulation experience that used actor-controlled avatars in a mixed-reality simulation environment to practice collecting case history information and delivering diagnostic news to parents of a child client. All students completed pre- and postsimulation questionnaires that rated the impact of the clinical simulation experience on their confidence in demonstrating targeted clinical skills and their general attitudes about their participation. Additionally, five lead participants participated in follow-up interviews to gather data to best describe students' perceptions. Quantitative and qualitative data were recorded and analyzed. Results The majority of the students exhibited positive attitudes toward the mixed-reality clinical simulation experience and reported an increase in their perceived ability to apply several counseling skills (e.g., listening and selective feedback) following the session. Analysis showed that the perceived confidence levels on seven out of the 17 targeted skill items increased on the postevent questionnaire to a level of statistical significance and that the simulation experience was described as meaningful and supportive for increasing confidence. Conclusions Mixed-reality clinical simulation may be a useful tool for teaching interpersonal communication and counseling skills for students, including undergraduates, in CSD. Additionally, the use of mixed-reality technology in this study produced similar results seen with other clinical simulation methods such as standardized patients or computer-based simulations.