Purpose: Augmentative and alternative communication (AAC) systems are important to support communication for individuals with complex communication needs. A recent addition to AAC system options is the brain-computer interface (BCI). This study aimed to compare the clinical application of the P300 speller BCI with two more common AAC systems, the EyeLink board, and an eye-tracking camera. Method: Ten participants without communication impairment (18-35 years of age) used each of the three AAC systems to spell three-letter words in one session. Accuracy and speed of letter selection were measured, and questionnaires were administered to evaluate usability, cognitive workload, and user preferences. Results: The results showed that the BCI was significantly less accurate, slower, and with lower usability and higher cognitive workload compared to the eye-tracking camera and EyeLink board. Participants rated the eye-tracking camera as the most favorable AAC system on all measures. Conclusions: The results demonstrated that while the P300 speller BCI was usable by most participants, it did not function as well as the eye-tracking camera and EyeLink board. The clinical use of the BCI is, therefore, currently difficult to justify for most individuals, particularly when considering the substantial cost and setup resourcing needed.