Advances in information technology bring progress in distance education. Online education programs are pervasive, however, only recently has the Web 2.0 brought about interactive, dynamic distance based health care education in virtual worlds (VWs). VWs allow for real time representations of environments, manipulable objects and interactions between avatars or bots, creating a sense of realism and presence that is absent in traditional, flat online education. Presence has been linked to knowledge transfer and better learning. Second Life®, currently the largest virtual world, has been used in higher education, including health care education at the Duke University School of Nursing. Students have indicated higher levels of satisfaction with the learning environment and quality of instruction in this VW compared to other online learning systems. There is a need for further research in online education in VWs, and room for growth in applications of VWs in education.