For simulation to be effective and achieve long-term sustainability as an educational strategy, institutions must have adequate and ongoing availability of training resources, trained educators, and curricula. This chapter explores stakeholder considerations in adoption and implementation of simulation programs. The chapter then discusses the cost considerations of manikin-based and virtual simulations, revenue generation, and return on investment. Ultimately, the widespread use of simulation education at the pre-service and in-service training levels is driven by health professional schools, hospitals, accreditation bodies, and health professional associations. This chapter discusses the role of faculty development and outcomes-based research in the global dissemination of simulation education.