KC Collins and Bill Kapralos investigate advances in spatial audio rendering for video game sound and discuss the pros and cons of the technology within the framework of realism. The authors first provide an overview of human localization of real-world sound, attempts to emulate these real-world conditions in virtual reality and video game audio technology, and the problems encountered in doing so. They then turn to the psychology of hearing—in particular, the role of attention and focus in our sound perception, and the importance of using sound design for emotion and expression. Collins and Kapralos argue that, in using sound as a “tool of realism” in video games, the artistic power of sound is lost: the belief that technological advances in spatial audio’s emulation of the real world produces realism, or even hyperrealism, is misguided, and what often results is an anemic hyporealism that lacks the imagination both game and player require.