Purpose: Rural populations face healthcare access challenges, including rural care provider shortages and rural hospital closures. Simulation-based education could help prepare prelicensure nursing students to address healthcare access challenges for rural populations in their nursing practice through an empathetic approach, however, there is minimal evidence comparing the effectiveness of simulation and to non-simulation education methods on this topic. The purpose of this study was to compare the effectiveness of a simulation and non-simulation online nursing education intervention on nursing student empathy, confidence, knowledge, and advocacy to care for rural populations.