Campus closures during the COVID-19 pandemic led to the innovation of online standardized patient (SP) simulations. Extensive preparation with the faculty, simulation specialists, SPs, and 42 occupational therapy students was required to smoothly adapt an occupational therapy learning module from in-person to online simulations. The concepts of "functional task alignment" and "psychological fidelity" from the simulation literature guided the process of designing the online simulations. Post-simulation, student perceptions about learner engagement, psychological fidelity, and accomplishment of the simulation's learning outcomes were collected using anonymous surveys. All 36 survey respondents found the online SP encounters to be engaging. Most experienced realism in their emotional responses as well as the interpersonal and cognitive skills used during the simulation. Overall, students felt that the online simulations provided an effective way to meet the intended learning outcomes. Additionally, five individual student interviews were completed to further explore the students' overall experience as a simulation participant, challenges encountered, and how the online simulation experience could be improved. Emerging themes from the interview data were: (a) a stepping stone for learning, (b) realism of the experience, (c) physical fidelity, (d) limitations of being online, and (e) curriculum design and implementation. Findings suggest that online SP simulations are a promising innovation with multiple potential applications in occupational therapy education during a pandemic and beyond.